OPEN

THE PSYCHIATRIST AS A CONSULTANT TO SELF-HELP

David

Spiegel,

GROUPS

M.D.

SAs mental health professionals, we have no special educational, vocational, or political qualifications to be social managers. Nevertheless, because of our intimate and ongoing contact with patients, we have some reason to be concerned about the world they face. Consultation has been a major method by which we as mental health professionals both in government and in private practice have attempted to influence the political, economic, and social context in which our patients must live. Mental health professionals in community, academic, and private settings can be viewed as a public resource of consultative knowledge and skills. Among other things, we have expertise in the group process, in dealing with emotionally disturbed individuals, and in appreciating the role that unconscious process plays in everyday life. Judicious use of such knowledge can help an organization function more effectively. Traditionally, the mental health professional has worked through various public agencies involved with facets of the social system such as education, welfare, and criminal justice. However, an alternative to the traditional work with public agencies exists for the community psychiatrist eager for political involvement: consultation to selfhelp and mutual-support groups. A growing number of these groups exist, organized around such diverse human conditions as alcoholism, drug abuse, divorce, homosexuality, mental illness, breast cancer, burn injuries, and gambling. Although the groups have had a varied impact on their members and on society as a whole, they have had a significant political impact on the communities in which they operate, since they of-

FORUM

ten move from internal consciousness-raising to political activism.1 The concept of a mental health professional lending his expertise to a self-help movement is hardly a new one. In the early part of this century, Clifford Beers, a former mental patient, sent copies of his book, A Mind That Found Itself,2 to the prominent psychologist Wilham James and psychiatrist Adolf Meyer. They subsequently became his active supporters, helping him to found the first citizen-run mental hygiene organizations, forerunners of the present-day Mental Health Association. By thus lending their prestige and expertise to Beers’ endeavors, but not directly involving themselves in the political process, James and Meyer had a profound impact on general social attitudes toward mental illness. By its very nature, the self-help group can often accomplish more than can the concerned professional alone. It has the political legitimacy of being a group of citizens organized around an issue that is important to them. Further, it has large numbers of potential memhers to draw on for support. Finally, such a lay group can be unruly, irreverent, and committed in a way that is often appropriate for political activism, but inappropriate for professionalism. Many mutual-support groups have been helped, especially at the beginning, by a mental health professional. In 1972, psychiatrist Matthew Dumont, M.D., then assistant commissioner for drug rehabilitation at the Massachusetts Department of Mental Health, urged those involved in various drug programs throughout the state to organize into a consumer group for the rights of drug abusers.3 He explained that even the most sympathetic assistant commissioner has a politically fragile and time-limited appointment, whereas an organized group of consumers can struggle as long as they are willing to. The group was remarkably effective 1

D. Spiegel,

and Mutual Dr. Spiegel is assistant professor of psychiatry and behavioral sciences at Stanford University School of Medicine, Stanford, California 94305. He also is chief of psychiatric community services at the Palo Alto Veterans Administration Hospital. He acknowledges the assistance of Arthur Freeman, M.D., and Helen Blau, Ph.D., in preparing this paper.

“Going

Help:

Public

Multidisciplinary

Killilea,

editors, Grune C. Beers, A Mind

& Stratton,

and

Self-Help,”

in Support

Explorations, New

York

City,

G. Caplan 1976,

pp.

Systems and M. 135-154.

2 That Found Itself, Doubleday, New York City, 1948. S M. P. Dumont, “Drug Problems and Their Treatment,” in Amencan Handbook of Psychiatry, Vol. 2, revised edition, C. Caplan, editor, Basic Books, New York City, 1974, pp. 287-293.

VOLUME

28 NUMBER

10 OCTOBER

1977

771

in competing for federal funds and opposing state federal programs that they considered detrimental the rights of former drug abusers. Such

groups

often

provide

support

and to

to professionals

as

well. A group called Parents of Adult Schizophrenics opposed staff cutbacks that would have reduced treatment services in a county mental health program in California. Group members made a determined visit to the local hoard of supervisors to tell them so. As a result of that visit the board decided not to make the cuthacks, much to the satisfaction of the professional staff, who had tried unsuccessfully to have the policy reversed. My experience with self-help groups has involved consultation to a group active in burn prevention. The group, the Northern California Burn Council, was started in 1975 by Andrew McGuire, the former director of a similar group in Boston. The Boston group, Action for Prevention of Burn Injuries to Children, had received its initial Support from John Locke, a government demographic expert in burn injuries, and John Crawford, M.D., chief of pediatrics at the Shriners’ Burns Institute in Boston, who collaborated with parents of some children who had been burned and with other individuals who themselves had been burned when they were children. The group’s development benefited from the early support of these professionals. The Northern California Burn Council has been effective in educating the public about the efficacy of using flame-retardant clothing, in introducing burnsafety information into schools, in working with recent burn victims, and in educating professionals who deal with burn victims. My consultation work has been flexihle and informal. It has involved planning for the clinical aspects of the council’s program of group meetings of recent burn victims, participating in the board of directors’ meetings, and writing statements of support for grant requests. The group has made good use of limited professional time and has had impressive impact. However, work with self-help groups is not exempt from the normal kinds of problems mental health professionals often experience in more traditional consultation roles. Requests for consultation are often ambivalent; some members of an agency or group may oppose having consultation, while other members may arrange for it. In addition, the consultant may be used by one subgroup for its own political purposes. The psychiatrist may become the object of suspicion, since it is a common misconception that psychiatric consultants use their knowledge of psychology to stir up emotional problems or to make embarrassing revelations.4 Furthermore, the power of psychiatric consultation is at times oversold, leading to disappointment in the consubtant’s

In

actual

comparison

4 D. Spiegel and Services Agency.”

accomplishments.

to

large

B. Naparstek, Psychiatric

HOSPITAL

5

A.

Help

Low, Mental in Psychotherapy

Boston, 6

M.

February

Health Through as Practiced

Will-Training: by Recovery,

“ Psychiatric Opinion, Vol.

agencies,

Consultation 11,

August

self-

to a 1974,

&

COMMUNITY



Alcoholics

1975,

Anonymous,

I,”

Psychiatric

Annals,

Vol. 5,

pp. 22-61.

SOME RETROSPECTIVE IMPRESSIONS OF PSYCHIATRIC PROGRAMS FOR TREATING CHILDREN Louis

Fairchild,

Ph.D.

#{149}Whena person

is involved on a full-time basis with a and is so much a part of its operation, he has difficulty being completely objective about its strengths and weaknesses. Since leaving the staff of a children’s psychiatric facility, I have spent several years in an academic position, which possibly has provided me with a more objective perspective. Since I am a part-time consultant and spend more time observing, I have had even more opportunity for reflection. The first impression to surface was the realization that there is no single best way to run a treatment program for children. As there is no only’ way to rear or educate children, neither is there any one way to treat them in an institutional setting. The authoritarian treatment

program



Legal

pp.

PSYCHIATRY

A System of Selfinc., Christopher,

1950. Bean,

‘ ‘

government

30.

772

help groups tend to be relatively transient and fluid, with less clearly established patterns of leadership and funding. Their members may be less interested in or respectful of professional support. Nevertheless, many self-help groups want such assistance. The classic example is Recovery, Inc., a large self-help group for former mental patients, founded by psychiatrist Abraham Low. Dr. Low is revered by the group and his writings are read religiously.5 Other groups, such as Alcoholics Anonymous, are officially critical of the medical profession in general and the use of drugs in particular, but most chapters, nevertheless, cultivate good relationships with physicians in their areas.6 Professional consultation to a self-help or mutualsupport group offers an important alternative to traditional agency consultation. However, such a role has limitations. What one loses in his contact with self-help groups is a sense of omnipotence. One is able to advise and suggest but not to decide which course of political action is to be taken. That is the prerogative of the citizens. Mental health professionals may well be advocates, hut ought not to be political leaders. While we may use our expertise to try to improve the life of the community and of the individual patients with whom we work, we cannot and should not decide issues of social policy based on technical, therapeutic, or political considerations. Such approaches may seem enlightened and humanitarian, but they have a tendency to become elitist and autocratic.

25-

Dr. Fairchild is an associate psychology at West Texas

professor

State

and

University,

head of the department of Canyon, Texas 79016.

The psychiatrist as a consultant to self-help groups.

OPEN THE PSYCHIATRIST AS A CONSULTANT TO SELF-HELP David Spiegel, GROUPS M.D. SAs mental health professionals, we have no special educational, v...
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