Obviously, I’m a mental health therapist, and this may be a career quite different from yours. But, if I’m not mistaken, even if you have no understanding or interest in therapy, you too know the utter frustration of working with an organization that seems preordained to miss the point.

I’ve been in numerous treatment meetings in different geographical locations where we seemed to be missing something, despite our best efforts. Usually, the setting is a non-descript and somewhat worn table in a tiny conference room. I associate these spaces with fluorescent lighting, illuminating the stage for massive amounts of projection, and the predictable enactment of job titles and social roles.

This treatment team I’ll describe here was better than most.

I’m the assigned therapist, the person who has spent many hours with the “patient.” Supposedly I’m here because I have experience and am skilled clinically. But my case presentation is met with unregistering eyes.

People at the table make references to systems of classification that sound important, primarily the DSM, which has become increasingly influential over my lifetime. Indeed, it’s the language of our time, used to describe things. Not just a list of behaviors, but factual things that exist in the real world, vaguely hereditary. By adopting its tone of certainty and pseudo-scientific lexicon, our meanest gossiping can sound like a diagnostic assessment.

At this table:

Patients are borderline.

I wonder, Does that mean they were traumatized?

They are addicts.

I wonder, What pain is driving it?

They are narcissists.

I wonder, Are they just describing someone who is mean spirited?

They are resistant.

I wonder, What part of this person is resistant and to what?

They are “needy.”

I resist, That’s not really a trait, is it?

They are co-dependent.

I know that’s not in the DSM.

I’m not feeling smug as I tell you this. I’m no different. I spent years playacting in these rooms. Ultimately, I know all of us have good intentions. But, here, these “diagnostic” words seem like insults, though the language offers the impression that every speaker is saying something carefully formulated. Adding to the stage craft, presentations follow a format. We start with a psychologist who explains test results or a psychiatrist who has some special summary that triggers the confirmation bias. This is a medical model at its core after all, and doctors go first.

Nurses have their say.

Mostly it’s all anecdotal.

But there are always the knowing nods. There are always the expected funny statements that might derail the group into stream of consciousness or gallows humor.

I’m not blameless here. I specialized for a time in flat-affect sarcasm. Like rolling my eyes but with my words, my tone. It creates a moment between my delivery and a listener deciding if I’m serious or not. My family of origin taught me how to survive by being the clown, the sardonic fool. Cynicism kept me well protected. I learned this so well it has taken decades to unlearn it.

Everyone here is a skeptic, even when they are drinking the same Kool Aid as hurriedly as their coffee or chilled caffeinated beverages. Everyone is also very clever. You can only survive at this table if you’re clever enough to repel any attack.

Who mounts the attack?

There are the regular chart audits usually performed by someone in the organization who has a checklist and little knowledge of the bigger picture or of the practice in general.

There are information systems you battle that will change periodically, always seemingly to make matters worse.

There are insurance companies that have their own special dictates. They can withhold until the financial coffers are hollow-eyed and wasted.

There are professional organizations that can take away your privilege to make a living.

There are the clients, patients, consumers (every agency has their own language to describe the people we help) who can sue you. Even if what they claim is nonsense, your life can be turned upside down and made miserable by a complaint.

There are the family members (client families, and maybe your own family members) who suspect you have no idea what you’re doing.

There’s the internal critic that agrees that you have no idea what you’re doing.

There are supervisors who are supportive—unless anyone complains, then you will likely get thrown under the proverbial bus.

There are your co-workers (loosely called colleagues), who suspect that you’re violating some law or principle (because deep down they suspect that they probably are, too).

Then there’s the basic mistrust by a lot of people in our culture of the work.

Not to mention the lack of pay. The lack of respect. You just need to accept that you will never be compensated for what you do, nor will anyone realize what you’ve done, even when you’ve blossomed with experience into an astonishing healer, even if well informed and always going above and beyond the call of duty. So, you get a little bit paranoid. You’re ultimately alone. Whether in a small agency or large organization, you’re essentially in private practice. At least you practice privately. You close the door. You face the next wounded soul.

Everyone is Selling a Product

            In traditional treatment, however well meaning, the expert maneuvers the client into adopting their “evidence-based” theory of the case and the interventions that dovetail with it. It’s no doubt manipulation. Don’t kid yourself. In traditional addiction inpatient treatment, the “patient” is supposed to be completely (or nearly so) incapable, because the brain’s reward pathway has shot-circuited, by definition, impairing decision-making. When a person struggles, the answer is always to increase treatment, the length of stay, the intensity of focus. Don’t address trauma immediately or other sources of pain because that makes it harder for an addict to stay sober. Avoid family history or adverse childhood experiences. Keep them caged in a “program” until the brain calms down.

In mental health treatment, as practiced in huge corporations selling those well marketed continuums of care, the caregivers aren’t therapists. They are “case managers” who leverage the “consumer” through megalithic psychiatric systems. If the consumer struggles, then the provider surrounds the individual with increasing supports and reevaluates their medications—avoiding family history or adverse childhood experiences (sound familiar?) and what has been too long denied or minimized (because it’s a chemical imbalance).

In traditional child and adolescent treatment, it is similarly limited in focus. In one organization I worked for (briefly) in St. Petersburg, Florida, on my first day I was handed a caseload of several hundred children and teenagers. It became quickly evident that I was employed to keep the paperwork current so that the young people could continue to be medicated by the team of psychiatrists and physician assistants. When I attempted to sift out the systemic dynamics (in families, schools, churches, etc.) and the social inequities that were re-traumatizing these children daily, such a tact was not well received.

Now to give credit where credit’s due (my mother’s relentless voice), some of these systems can be helpful when we’re in crisis. When the prescription is carefully, artfully tailored, their costly services might help us feel less miserable, but they are not designed to help us grow into our own Truth and to recognize Beauty.

 Escaping the Dissociated World

Looking back, knowing what I know now, I see in its various forms how dissociation is an outcome of living in a traumatizing society. Often the pressures start in our families with our parents and siblings; the demands that we follow rules and roles without questioning them. We absorb judgements about who we are.  My parents’ clichés, though not thought out, were effective at sculpting my limitations. Perhaps your family members had sufficient education, social significance, and awards on the wall that they proclaimed what is real or right or healthy in more logical words and persuasive arguments. Backed up by their “heritage.” multigenerational legacies, some families openly and grandly carry the receipts that delineate success from failure. And their children must carry on. Or on the other hand, maybe the opposite was your experience, expectations were spoken with a languageless brutality, backed by the chaotic, uneducated weightlessness of a leaderless family.

            However, it starts for any one of us, in our homes and neighborhoods we learn to don the headphones of a virtual (dissociated) reality. And then schools, our peer groups and careers continue with similar narratives, punishing us if we ever remove the headsets, ridicule us if we resist. By young adulthood, we will all be assimilated by the full weight of some unimpeachable Power that demands loyalty.

For many of us, the places we pass through in our development beyond our family are environments in which our mammalian hearts cry out to belong and to heal and to grow—yet are not safe. They are the dangerous prowling grounds for Outcasts, and Workaholics, Narcissists and Sociopaths. In such landscapes we learn to Play at Love, to Work for Love, to Work for Power and/or to Play at Power. These are survival roles, adopted characters that seem to be effective in the Fallen World, allowing us some “solution” as long as we live outside ourselves, in a protective defense that pillows against what we dare not face. Dissociated and safe. Where we can be fuzzy about our body, our gut and heart, our emotional currents and wisdom. We can settle for a character’s life in someone else’s story, and never claim our innate powers to see, to know, to hear, to question, to refuse and to imagine, to disagree etc. Dissociated and safe. Secure in the bubble of a busy and mindful intellect or in mindless escapes.

The way out is the way through, and in the pages to follow I will suggest a path, a Heart-drama, a process, work we all need to do to pierce the dissociation and question the Barriers and finally claim a life of meaning and purpose.