The care and treatment of the severely and chronically mentally ill is the most common problem faced by the mental health profession despite the fact that to date the care of these individuals has probably had the lowest priority in the entire area of human services. In a recently published family manual, Torrey asserts that the magnitude of schizophrenia as a national calamity is exceeded only by the magnitude of our ignorance in dealing with it. In his words, "Schizophrenics are the lepers of the 20th century."
As the trend of "deinstitutionalizing" the severely mentally ill has followed that of warehousing them in state hospitals, it has become clear that, primarily due to lack of planning and funding for adequate community resources, many tend to function marginally in the community and that hospital readmissions have created a revolving door syndrome. The problems of getting schizophrenic persons adequate care in a state hospital setting are magnified exponentially by the difficult conditions awaiting patients after discharge.
The following article is a description of a unique treatment approach within an innovative community setting in the Boston, Massachusetts, area in which I participated a few decades ago. It has been written as a means of sharing a story of success in work with individuals designated as mentally ill in a period described by many as the national "debacle of deinstitutionalization."
A Unique Treatment Approach
When I joined the staff of this community aftercare program some years ago, I was intrigued by a sense of vitality, dynamic optimism, and clarity of purpose which appeared to bond colleagues together. Clients gathered daily to participate in milieu, group, and individual therapy, to spend time with one another, and to soak in a sense of belonging. Clients' family members eagerly participated in groups designed for support, education, and self-help. Frequently, they expressed their sincere gratitude to staff - strongly contrasting with numerous past instances of feeling accused or ignored in dealing with mental health professionals. Clearly, something was working.
In recent years, I had also made acquaintance of psychosynthesis, a therapeutic approach designed to facilitate the growth and integration of the human mind, heart, and spirit. As its founder Roberto Assagioli stated, the basic premise or hypothesis of psychosynthesis is that there exists, in addition to aspects of the unconscious revealed by psychoanalysis, "another vast realm of our inner being which has been for the most part neglected by the science of psychology, although its nature and its human value are of a superior nature."
As such, psychosynthesis represents a new branch of psychology which has been given the name "transpersonal" and which incorporates a "height" as well as "depth" dimension.
Seeking to understand and relate to the totality of the human psyche, it exists as a clear contrast and complement to the more reductionist approaches which tend to consider all human experience as either an adaptive or a defensive process. Psychosynthesis seeks to direct our vision toward potentials for growth and evolution latent within - toward, as Assagioli writes, "the grand promise of what each person could become."
In my work as an aftercare therapist within the clinic, I applied the principles of psychosynthesis. Most individuals, who had been discharged from a state hospital near Boston, carried a primary diagnosis of schizophrenia although diagnoses of borderline personality disorder and bipolar affective disorder (manic-depressive illness) were also common. For the sake of simplicity, I am limiting this discussion to work with individuals diagnosed as schizophrenic.
Due to the nature of the therapy team of which I was a part, and its place in the delivery system of mental health services, much work was involved with the family members of clients. I functioned as both family therapist and group leader in the network of support and education groups developed by the therapy team.
Extensive contact with other professionals was involved in both hospital and community settings. Such a setting has been ideal for the testing and integration of a psychosynthesis approach in a variety of situations. Application of concepts within a psychosynthetic framework could be compared with strategic and systemic modes of family treatment, as well as more psychoanalytic, medical, and psychosocial/educational rehabilitation models.
Because the psychoeducational, family-centered approach utilized by the aftercare therapy team was itself an innovative one and because our mandate was to provide a range of aftercare services to the most difficult clients in the region, other professionals (trained in more traditional approaches) tended to expect creative, occasionally surprising clinical plans from team members. This process was, of course, not without disagreements and conflicts, but these situations tended to throw into relief the various clinical assumptions of the care providers.
As time went on, I became aware of an interesting process. Many members of our agency's clinical staff appeared to be applying principles of psychosynthesis instinctively and intuitively despite having had extensive formal training in clinical approaches substantially different from psychosynthesis. Clients were held in a perspective of wellness as well as illness, and client disempowerment due to diagnostic labeling and self-fulfilling negative expectations was kept to a minimum. The atmosphere of the clinic was often joyful and sincerely caring, despite the severe dysfunction of many clients and the high case-load of staff members.
I began to notice that what was held by the staff as a group was an "attitude of synthesis." This attitude of synthesis had to do with an openness of mind in being willing to innovate in search of practical therapeutic results. It had to do with a faith in people's innate inner resources and an openness of heart which embraced clients and colleagues in an ongoing demonstration of the power of love and acceptance. It had to do with the reality that often it is only through the combined efforts of staff members that a client is able to take their next step in growth, or simply be kept from relapse and breakdown.
It was understood that to be effective, colleagues needed to intervene with clients at multiple levels, and to utilize data from many points of view. While such an attitude is difficult to express in words, it appears to be essential to the human growth process itself such that opposite qualities - work and play, feelings and mind, love and will, practical and ideal - can interweave and play upon one another toward ever higher levels of integration. As Ferrucci states, such syntheses release enormous amounts of psychological energy, leading to a positively spiraling growth process.
The following discussion is designed to be of interest to two audiences: those who are acquainted with psychosynthesis but have little knowledge of chronic mental illness and those who wish to provide comfort and therapeutic help to the mentally ill, but have little or no experience in the discipline of psychosynthesis. Herein, I seek to describe some hazards as well as advantages of a psychosynthesis approach.
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