Having talked a little about my introduction to neurodiversity (previous post), here is how I personally explain radical mental health and how I would like to see things change.
I am including my own experiences to serve as examples, but must emphasize that experiences may vary significantly between individuals. And this is exactly the point; that we are all unique individuals with different experiences, so our paths in navigating these experiences will also be different. Most of these points just have to do with allowing for diversity, eliminating stigma and necessary pathologization, and empowering individuals that often come to mental health systems from a very disempowered position.
Question necessary pathologization of neurodivergent experiences.
The experiences I have of my mind and the world around me are definitely neurodivergent (in that they deviate from the “typical” and “expected”), but I only pathologize some of these experiences. For example, I see my plurality (multiple personalities/selves) as healthy when navigated well, but tend to view some other characteristics through a more pathologizing lens. My point is not that we should end all pathologization of mental health experiences, but rather that our choice to pathogize or not is ours to make. Viewing certain things through a pathologizing framework can be both disempowering (as we see ourselves as ill) and empowering (as we have identified an issue and are then able to seek supports and treatment, and maybe be more kind and forgiving to ourselves). Avoiding a pathologizing framework can also better allow us to see some positive elements to our neurodivergence, and even take pride in this.
Allow people to conceptualize and navigate their experiences in a way that works for them.
We are unique individuals with unique lives and circumstances. We also (likely) have access to the internet where we can find other individuals with non-mainstream narratives around mental health, and ideas for navigating neurodivergence not found within mainstream psychiatric and psychological systems. We need to listen to people and be open to what works for them in terms of how they understand their experiences, and what they have found to be helpful. If a therapist, friend, etc. thinks we are not on the right track, it may be important to share that new information and then allow us to take things from there. Rather than force us into a typical mental health category with standard treatment, share the new information and then allow us to revise (or not) our own understanding and mental health strategy.
Allow people to self-identify with categories of mental illness.
Relating to the previous point, we might actually understand our experiences in a way that is in line with mainstream psychiatric or psychological systems. And we might want to navigate things in a entirely standard way. My own identification with (quiet) borderline personality traits (albeit a way that deviates from the DSM) is not in line with any previous psychiatric assessments (where the focus was more on whether I was bipolar or not). But we may know ourselves better than a psychiatrist can assess, and this understanding has far more explanatory power and allowed me to access better tools and resources than any previous nonconsensual mental health label application. Psychiatrists shouldn’t be gatekeepers to mental health categories that provide access helpful drugs and therapies, not to mention a sense of legitimacy in our self-understanding.
Provide access to psychiatric and other drugs on an informed consent basis.
This includes being more honest and informed about psych drugs, their potential long-term side-effects (or that these effects are unknown), and potential symptoms one might experience upon discontinuation. I started SSRIs and benzodiazepines at one point in my life, with none of this information presented to me. Getting off of the SSRIs in particular was very difficult due to “SSRI discontinuation syndrome“. Access to drugs on an informed consent basis should also include “recreational” drugs if the client believes they would be helpful, i.e., medicinal marijuana, MDMA with therapy for PTSD, psilocybin for dealing with life changes, etc.
Provide support in changing, reducing, or eliminating psychiatric and other drug use.
The Icarus Project has published a guide to coming off of psychiatric drugs, filling a devastating void that existed for many years. The systems giving us drugs should also support is in coming off those drugs when we feel the time is right.
Provide access to a wide variety of counselling and therapies as part of public health care.
A wide variety is key here. Even though I am lucky to be able to access some public mental health supports, they often do not meet my needs. As someone that is queer, uses kink as part of their mental health strategy, and embraces their neurodivergence, I have had much better luck finding a counsellor outside of the public system. But many of us cannot afford weekly therapy from a private counsellor.
Provide client-centred care.
Reverse the power structures often found in psychiatrist/client relationships, to provide care where the client (often coming from a very disempowered position) is empowered with guidance to make their own decisions. Recognize the need to revise models to fit client experiences, rather than invalidating or ignoring experiences that do not fit the model.
Recognize the contexts in which neurodivergent experiences fit.
How do the client’s experiences and identities fit in with the dominant culture around them? For example, are they queer in an environment unsupportive of anything other than the hetero-norm? Are their experiences pathologized because they are inherantly bad, or because they are difficult to navigate given the world we live in? This includes things like being gay or transgender (which used to be explicitly considered an illness in the DSM), but also things like being autism-spectrum or having a “personality disorder” — where at least some of the issue comes from being different than typical, and not the characteristics themselves.
There are many other changes required to mainstream mental health systems in order to better support and empower individuals with mental health challenges. These changes in particular come from my own experience with what I have found to be helpful (especially with my own therapist), versus unhelpful or damaging (especially in the public system). Others’ visions and experiences may look different or include additional elements, and also form an important contribution to this dialogue. So let’s listen to each other, share our stories, and continue working towards a more supportive and less oppressive world.
