SAMHSA: ‘Shaping the Consumer’; Personal Insights from Lori Ashcroft, Ph.D.

Among other things, I am a mental health consumer—a “patient.” I have been shaped by services I’ve received for symptoms I’ve experienced. I’m going to tell you what this was like for me. I hope sharing my experiences will give us some common ground as we examine how a system of behavioral health services can actually shape an illness—and the person who has that illness—in a profound and penetrating way.

In my experience, it was a struggle to understand what was happening. I came to believe we “consumers” were just born that way. Something had gone wrong somewhere along the line and we ended up with a combination of characteristics that made us mentally and emotional vulnerable. The concept of being vulnerable was more palatable to me than things I learned in my Psychology 101 class, so I stuck with it.

As my “vulnerabilities” progressed, I became more desperate for answers. I thought if I could just figure everything out, I could solve my problems. So I kept going to school. But as I became more and more educated about mental illness, the notion of being born a certain way, with no cure, penetrated my belief system.

These beliefs were reinforced by those from whom I sought treatment, since the focal point of their interest was my symptoms. They seemed to tinker with and talk to my collection of symptoms rather than address me directly. Once they were able to diagnose me, they breathed a sigh of relief—as if the diagnosis had revealed who I truly was and how to treat me. They were relieved by the same information that devastated me. What I really needed to hear was this was something I had, not something I was.

I felt ashamed and guilty, so I learned to hide—to pretend I wasn’t depressed, anxious, or addicted. I took a lot of medication and spent the next 20 years living a dual reality. I was very good at pretending, and while this left my internal world lonely and unreal, it actually served me in a strange sort of way, as others expected much more from me than I ever thought myself capable of. As I struggled to meet their expectations, often surprising myself, I was holding on to a position in my life that appeared to be strong.

It didn’t occur to me to question the belief that I was “born that way,” with no cure. But when asked to teach a graduate class on trauma at a local college, my perception began to shift. The materials I used to prepare for classes challenged my basic unexamined perceptions of the impact trauma had on the development of reactions that could mimic symptoms.

I found myself refereeing between this new insight and my old beliefs. Were we born this way, or did life circumstances cause us to be this way? Or was it both? Focusing on these questions, I avoided thinking about the painful suspicions emerging from the shallow graves in my mind where I’d buried them. I hide things there that scare me.

One of the scary thoughts I had buried was related not only to me, but to my work on trauma. I began to wonder if the things we were doing to help people actually caused them to get sicker and more disabled. Even scarier was a question I had about myself: Was I making myself crazier and more vulnerable by clinging to beliefs about myself and my various mental illnesses? As far as I could tell, neither belief opened the doors for regeneration or recovery. Furthermore, what did holding on to them tell me about myself?

Finally, the mother of all scary questions unearthed herself: Who the heck are you then? It was the question we all ask ourselves eventually. Sometimes we can answer it genuinely, and sometimes we just make up stuff that sounds good. I didn’t know the answer and was tired of pretending I did.

At that point I couldn’t, with any confidence, tell you who I was. But I was beginning to recognize who I was not. I was not any of my diagnoses. I wasn’t the damn eating disorder or any of my physical conditions or unreliable emotional states. Yes, I have these things, but they are not me. I am much more than a bunch of diagnostic descriptions and unfortunate experiences.

Years later, I learned about the concept of recovery from mental illness. This single bit of information changed my life. If I could recover, I wouldn’t need to keep so many things secret anymore. The moment I came to this realization was when I began to see myself differently. My vulnerabilities were still there, but my stronger self began to emerge and overshadow them. I could finally get over what I’d been hiding. Furthermore, I could let it teach me instead of scare me. I could learn from it and gain courage by facing it and mastering it. I could own it instead of covering it up. And maybe when I knew how to use the parts of me that were “broken,” I could teach others how to do the same. Perhaps these were my best gifts.

For decades, experts have told people that they were sick and damaged and that their chances of ever getting better were slim. Perhaps these people have had to bend themselves around a diagnosis that describes only their broken parts and excludes mobilization of their strengths and abilities. Maybe they have been held captive by identities they took on at the insistence of service providers from whom they first sought help. Could this be how the system has shaped consumers who use such services? Because there were few other reference points, the system was the defining and uncontested voice that defined us.

Many of us have been affected by illness and addictions and, because of these experiences, have forgotten ourselves. We’ve forgotten that, buried underneath our symptoms and diagnoses and conditions, there is still a well person begging for inspiration and support to wriggle free.

Dr. Ashcraft is Director of the Recovery Opportunity Center at Recovery Innovations, Inc. Contact her at lori.ashcraft@recoveryopportunity.com.