20 commandments 20: Thou shalt help your client to keep up hope

I’ve mentioned the International Study of Schizophrenia (ISoS) already in this series. That’s the World Health Organisation’s study that followed people from all over the world from first diagnosis of schizophrenia for 25 years.  In the rest of the world rates vary and it’s true that some cultures have even poorer recovery rates but some are very much better. In some communities the recovery rate rises to around 90%.

It’s no accident that I used the word ‘communities’ in that last sentence. It seems that the quality of a person’s social involvement and the nature of that group’s cultural beliefs and expectations has a major impact upon the prognosis for mental disorders.  We know from research dating back to the early 1950s that the effect of social involvement and the quality and type of social interaction has a massive impact upon the likelihood of relapse and conversely upon the probability of recovery.

We know from research in education and also on personality disorder work that expectation and socio-cultural norms make a massive difference to the likelihood of recovery from all forms of distress and mental disorder. We know that involvement is the key.

surprising how little intervention and interaction can make the difference. The wider world of UK society may have its prejudices and ill-informed bigotries but those of us who work in mental health services need not be so limited in our outlook. We can use our therapeutic influence to model the world in microcosm and find valued roles for our service-users. We can help the families of service-users to practice principles of involvement and help them to understand what can be achieved. More than that – we can help them to learn how to make positive change come about. Society at large may be ignorant of the possibilities but society at large is usually far less important and far less instrumental than the small social group that the service-user belongs to.

By influencing this small group to be positive and inclusive, to be encouraging and active the social and cultural stressors associated with mental disorders from anxiety and depression to schizophrenia and bipolar disorder can be kept at bay – at least long enough for the individual to develop their own robust coping strategies – to change their degree of vulnerability. And then – once the service-user has gone as far as they are able within our service they move on and begin the next stage of their journey – just like everybody else does. Circumstances change for us all as we develop and move beyond our current situations.

Just as we move on and grow from time to time so will our service-users so long as we are prepared to keep the possibility, the ‘therapeutic optimism’ alive.

Social interaction and social modelling is another, non-medical way to impact all forms of mental disorder as part of a whole system affecting a fully rounded individual who is far, far more than mere chemistry.

Based on the work of ‘Margreeth H.’    

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