Coming Out Of The Belly Of The Beast: Why I Decided Against Becoming an LCSW
I run a mental health training institute but I don’t have an LCSW, MD, PhD, or Psy.D. I always thought I’d get the satisfaction of having those letters after my name, but now I can’t imagine myself ever going down that route. I’ve chosen a different path. Here’s why.
Straight out of college, I told myself I was going to “work in the system in order to change it” as so many of us set out to do. Life schooled me on the many ways we can create change – in my case it was by going straight into the belly of the beast and committing to better ways of creating the changes I wanted to see.
Right out of school I got my first job in the mental health system as a crisis counselor, seeing families and children who just got out of the psychiatric inpatient unit. This was an intensive crisis program (Home Based Crisis Intervention) that required me to visit a client 3 times per week for 1-2 hours at a time. It was the deepest dive I could’ve taken into clinical work – doing psychosocial assessments, case management, IEP meetings, treatment plans, progress notes, and “psychoeducating” people on their diagnosis. Sometimes the job required me to report “non-compliance” when someone refused to take meds or missed too many meetings, and at the worst of times, involuntarily re-hospitalize them.
There wasn’t just one event that gave my inner moral compass big flashing warning signs. In a way, I went into this work knowing I would find many things unsettling about the system. I was undercover. As a trauma survivor and someone who had previously been diagnosed with 3 DSM diagnoses, even taken anti-psychotics for a brief period, I dedicated my adult life to understanding how we allowed the ‘medicate and separate’ model to dominate rather than seeking to understand the roots of people’s pain. Yet, there’s not a lot that could’ve prepared me for what I saw – a reality that rarely gets told when we talk about mental health.
I’ve witnessed a co-worker explain in a treatment team meeting that a 6 year old boy, already on 6 different psychotropic medications needed to be on a 7th because he was “batshit crazy”. I’ve seen a 14 year old client become re-traumatized from another inpatient visit where her psychiatrist upped her meds and told her to “fake it til you make it” regarding her depression. What I eventually realized is that each individual I had seen are all survivors of trauma, even if it’s not visible or easily recognizable. Each person had experienced the loss of a parent or sibling to the system or to death, gang violence or feared for their lives on a daily basis, poverty, housing insecurity, discrimination, divorce, immigration issues, family violence, emotional abuse. How was I supposed to psycho-educate someone on their disorder knowing full well the problem ran so much deeper than a biochemical issue? More importantly, how was I supposed to help when I was complicit in a system that erased their experiences under the guise of mental illness?
I came to understand that mental illness is a label, with little to no solid scientific backing, given mostly to marginalized people that allows society to continue mislabeling structural issues as a hereditary disease. It’s a label that allows us to provide referrals to services that are often needed but also typically only served to keep people in the system (whether the medical, education, or prison system) sometimes for the rest of their lives. I began to see that the whole thing was predicated on power. At large, we weren’t interested in supporting people at the root, we were interested in “fixing” someone who had been labeled a problem by society.
I have a lot of empathy for people working in the system. I know what it’s like to juggle cases, be on call 24/7, to give all your emotional support to clients, but to be burned out at the end of the day with a low salary and not enough sick days in the world to cover what your eyes have witnessed. We have to do better for all of our sake.
There are certainly some brave creative individuals out there, using their credentials to make real change on the inside. I happen to be good friends and colleagues with many of them in NYC at the Institute for the development of Human Arts, a non-profit we co-founded to redefine mental health services and train people on alternative models. To do this work, we NEED people working both on the inside and the outside of the system - people with all kinds of professional knowledge as well as lived experience. I, for one, am choosing to do this work from outside the belly of the beast.
Why? Mainly because I do not want to be restricted by the confines of the medical model, diagnoses, or the DSM. I do not want to be forced to apply a label that can stick with someone for the rest of their lives simply for the sake of insurance purposes. I also do not want to be held to standards of “care” that would force me to institutionalize anyone against their will. There are other options out there that are effective and humane and I want to focus on building those alternatives.
Additionally, it’s easy for any practitioner (in all fields, including peer work and holistic health) to not be aware of the power dynamics at play when someone comes to you feeling helpless or in need of support. I’ve found it to be easier however, to focus on mutuality, reciprocity, and empowerment in a helping relationship that is not defined by pathology and diagnosis, in which we do not consider one person as the “healer” and the other as “healed”. I also believe the spirit and body are highly involved in the healing process and desired the freedom to explore those domains outside of the western biomedical model.
So then, why practice holistic health?
For me, holistic health and peer counseling have become the foundations on which I lay my practice for these 3 reasons:
1) Mental Health Is Limiting
I practice holistic health because the mental health field has effectively been gutted into behavioral analysis, irresponsible drug prescribing, and institutionalization. As a prior crisis counselor I've seen a lot of what goes down in the field and the things we're NOT talking about like the effects of trauma, discrimination, human rights issues, environmental context, institutional issues like access to healthy food and housing. We have to start talking about what has happened in people's lives rather than focusing on what's wrong with someone's brain chemistry. (However, I do understand that some people desire medication, psychotherapy, and more traditional or intensive support, so I keep close company through the Institute with radically responsible psychiatrists and clinicians who offer this support. )
2) The Age of Specialization is OVER
Merely discussing the ways that the mind affects the body or the body affects the mind doesn’t quite get at the nuanced reciprocal relationship between all aspects of our being. I practice holistic health because sometimes talk therapy isn’t enough, sole herbal remedies aren’t enough, spiritual wisdom isn’t always enough, and nutrition isn’t enough on its own. We have to stop compartmentalizing our lives as though the foods we put into our bodies, the thoughts we think, the trauma we experience globally, are all isolated incidents. We can’t survive well in the age of specialization anymore. Wisdom is in the interconnections of the mind, body and soul.
3) Holistic Health is the Quickest Path To Transformation
Holistic health is more than a mere perspective or self-care practices, it’s an acknowledgement of the complexities of who we are and that our multifaceted qualities don’t stand alone. We need a diverse variety of tools to support our muti-dimensional needs. Working through the mind, body, and energy together, honoring emotions and healing through acknowledgement instead of pathology, is the fastest route to healing.