Article Type: Column
Subject: Pharmaceutical industry (Licensing, certification and accreditation)
Psychologists (Licensing, certification and accreditation)
Author: McAdams, James
Pub Date: 03/22/2011
Publication: Name: Annals of the American Psychotherapy Association Publisher: American Psychotherapy Association Audience: Academic; Professional Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2011 American Psychotherapy Association ISSN: 1535-4075
Issue: Date: Spring, 2011 Source Volume: 14 Source Issue: 1
Accession Number: 258131239
Full Text: "... for these reasons, Sharon's lack of adjustment during the first month concerns me," the program director concluded. To her right, the career personnel--the clinical psychologist, the licensed social worker, the case manager, and the physician's assistant--sat at attention, eating leftovers or salads from Tupperware. They took notes with pens bearing the logos of pharmaceutical companies. Across from them, the direct-care staffers leaned back in their chairs, their knees wedged against the table, eating candy and surreptitiously monitoring their cell phones. Despite numerous team-building activities, the two groups barely functioned as complementary. (It must unfortunately be noted that the former group was almost uniformly college-educated and Caucasian, while the latter were mainly minorities, paid hourly with no health benefits or 401 (k) plans.)

In addition to the weekly agenda, the ED. had Sharon's daily progress notes, compiled by the direct staff, and various assessments and prognostics composed by the professionals splayed before her. "I'm also concerned that there seems to be a tension between what Sharon is telling us here (gesturing to indicate the recovery unit) and what she's telling her doctors and case managers. But in both she references her books a lot, so I'm wondering if they are cases, good or bad for her." She turned to the case manager. "Kelly, what do you think?"

The case manager swallowed her bite of salad and pulled a binder from her briefcase. "I was thinking ..." she said, scanning a document, "whether there is a way to use her overattachment to these books--at least that's my view--to encourage her to begin writing her own memoir. I was talking to Abdaliz," she said, motioning to one of the direct-care workers, "and she reported having a discussion with Sharon in which she said what she liked about these memoirs was that they seemed to make sense to her, or be something to identify with, isn't that right, Abdaliz?"

"At the same time she said that they made her feel like a loser, like she wasn't mentally ill enough, or she didn't try to kill herself enough times or whatever." Abdaliz, who wore a bright orange parka with a puffy collar, was a young Hispanic girl with a 2-year-old and complicated braids. "I told her it wasn't about being the best at anything," she said, still leaning back in her chair.

The guy who stayed overnights during the week an English major at the local university--wondered aloud as to the titles of the books.

Abdaliz waited for the case manager to respond. At times like these, the case manager was given due deference, but after a half-minute, Abdaliz answered. "There's a bunch of them, a lot with Prozac in the title: Prozac Nation, Prozac Diary, Hearing Prozac--"

"I believe you mean Listening to Prozac, by Dr. Kramer," the clinical psychologist interrupted. "Not technically a memoir, really."

"Well, sure, yeah, so those, and then something by Sylvia Hath, her diaries or notebooks or something, and another book called Wasted. All the covers I saw had skinny white chicks looking all blah."

The case manager said, "So we thought maybe if she could write her own memoir, something to create a narrative or identity, that might be helpful, instead of just reading these books and comparing herself negatively, which she seems to be doing."


"Empowering," the psychologist murmured, writing and nodding.

"We've had book groups before," mused the ED., "but never really writing projects. Aside from journaling, that is." As an experienced team leader, the ED. had developed the ability to act outwardly along one train of thought while at the same time pursuing a more deeply internal one. In this case, her masked thoughts concerned her dissertation about memoirs of the sort Abdaliz had listed and how their consumption positively or negatively impacted recovery. After a moment's hesitation, she offered to personally oversee Sharon's memoir, an intervention she then requested Abdaliz and Kelly to start developing plans for. It was impossible to determine whether she acted in this way cynically or sincerely, until months down the road, if then.

Discussion: What impacts, especially for a client suffering from Unipolar Depressive Disorder or perhaps Borderline Personality Disorder, could reading--or writing--memoirs of mental illness have on recovery? Positive or negative? And why, in this case, is there a higher probability of one than the other?

JAMES MCADAMS is a graduate student at Villanova University studying English and cultural studies. Prior to obtaining his BA in creative writing from the University of Pittsburgh, where he also minored in psychology, he worked for over five years in the mental health industry, occupying such positions as house supervisor, resident advisor, and case manager. He is working on a novel concerned in part with representing the complexity of the mental health industry and its constituent personnel.
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