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Letter From The Editor: Transforming The Pain Beneath Misdeeds



The GroundUp has reconsidered its denial of the aspiration, the hope and the ideal condition for dealing with mental health issues. Hope after all is a powerful motivator for change and betterment.


Now, The GroundUp has never endorsed a "Dandelion Insurrection" free for all love of the soft offense darknesses of the world that often gets approved of depending on a person's identity. However, in the case of our project Research On Ethical Reinstitutionalization & The Indignity Of Mental Illness Normalization,

the language in the third paragraph, which previously read as: Explore these matters. Let's work towards a better understanding of the "is" of mental health rather than a desperate hope of the "ought." Let's construct a safer world. Send us your research on these terrains! will now read as: Explore these matters. Let's work towards a better understanding of the "is" of mental health, and rather than a desperate hope of the "ought," let's strive for an understanding of what ought to be–an inclusive society that provides proper care and support for all its members.


Reinstitutionalization is indeed a place for people to go when they can't be anywhere else. But in no way should reinstitutionalization return as a lazy excuse for not handling the mental health of a population. When exploring the dual challenge of reinstitutionalization and illness normalization, human rights and dignity are the ultimate concern: The priority should be to uphold the dignity and rights of individuals with mental health conditions. Reinstitutionalization, if not carefully managed, could lead to abuses and violations of these rights. Past instances of mistreatment in institutions have led to a push for deinstitutionalization and the development of community-based mental health services. However, deinstitulnization does not work.


The process of replacing long-stay psychiatric hospitals with less isolated community mental health services, began in the mid-20th century and was driven by a variety of well-intended reasons. But the infrastructure for deinstitutionalization never existed. And what exists now is a lack of community services; meaning, housing challenges, increased homelessness and incarceration, public perception and stigma, co-occurring disorders (such as drug addiction) and lack of continuity of care.


The matter now is that reinstitutionalization to a degree and to a certain extent must occur. The question is to what degree and to what extent!


Of course, this is a complex and sensitive topic that requires careful ethical considerations. Ultimately, it is crucial to balance the rights and needs of those with mental health conditions with those of the wider society. Let's explore a few important perspectives before turning to an analytical exploration and potential therapeutic solution that likewise does not deny that yes, some people need help, and no it's not okay to carry on performing dark deeds:

  1. Public Safety: If individuals with certain mental health conditions present a risk to themselves or others, there may be a need for institutional care.

  2. Evidence-based Treatment: Any approach to treating or managing mental health conditions should be based on the best available evidence. For some individuals, residential treatment or hospitalization might be necessary. For others, outpatient therapy, support groups and medication might be sufficient. The focus should be on what will best help the individual to manage their condition and live a fulfilling life.

  3. Social Integration: It's also important to consider how we can better integrate individuals with mental health conditions into society. This might involve providing better support for these individuals in the community, reducing stigma and promoting mental health literacy.

  4. Policy and Funding: The way mental health care is funded and policy decisions regarding mental health treatment play a significant role. Public opinion, political will and resources all impact the type and availability of care.

Now that we've explored the broad implications and considerations of reinstitutionalization and the normalization of mental illness, let's turn our focus to a real-world scenario. In understanding the complexities of these issues, nothing provides clarity quite like a analytical exploration. By examining how these principles apply in real-world contexts, we can gain a more nuanced understanding of what works, what doesn't and why. Additionally, it can help us develop therapeutic solutions that likewise do not deny that yes, some people need help, and no it's not okay to carry on performing dark deeds.


Now to be clear, the analytical exploration neither supports reinstitutionalization or a continued deinstitulnization. The case simply shines a light on the fact that there is an abundance of mental illness not being addressed in any capacity. The writing that follows also attempts to empathetically understand a personality disorder concomitant to the subject of the analytical exploration found on Psych Forums, histrionic personality disorder (HPD):


I imagine HPD is one of the most challenging disorders but not for obvious categorizations of difficulty. I will explain the reason why I find that this disorder would be particularly challenging to have, and I will do so by beginning with how this disorder seems to have some upsides.


Contrary to the Cluster C personality disorders (such as avoidant personality disorder), the various anxiety disorders, autism spectrum disorder, or ASD, and a multitude of other disorders that I have not exhausted, people with HPD have a natural persuasive dimension to them. People with HPD are excessively overdramatic, emotional and theatrical and they feel uncomfortable when not the center of others’ attention; behavior is often inappropriately seductive or provocative; speech is highly emotional but often vague and diffuse. Jennifer French and Sangam Shrestha note that people with HPD are “typically characterized as flirtatious, seductive, charming, manipulative, impulsive, and lively” (2022). People with the disorder even note that they possess a profound ability to enamor people!


Indeed, one of the most responded to threads within the HPD section on Psych Forums titled “Why we Have our 'Fan Clubs' (for HPD's ONLY)’” features one poster with the username AliceWonders who writes (2011):

My guys are great, and they love me no matter what I do. Their love for me is unconditional and right now- I NEED that. They have carried me through many things and I give back to them as much as I can in my time and attention in return- there is NO shame in that. I've excepted my fans back into my life and I've become more calm, less enraged and more confident in myself again. I'm learning to be comfortable with me and try to maintain some kind balance... I'm able to go outside again. I'm able to dream of a future again, because of the support and unconditional lovethey give me that I can't find anywhere else. Yes- the object will be to have real close intimate relationships when I am able to do so; but right now I'm to take the support where I can find it and gain strength from that. My guys know about my disorders, they know that I am dangerous and could use/hurt them at any given time and have been warned accordingly. they choose to take that risk and be there for me because they think I'm worth it. Do you have any idea how great that is? To be WORTH something?????

AliceWonders later clarifies this idea and writes (2011):

Fans are different. Fans are not friends, but those who have an attraction towards you and want to be in your inner circle; in your confidence and your atmosphere because they like the way you make them feel about themselves. Chances are you may share a few things in common, either that or the fan will bend towards things you like in order to please you and gain your approval. A fan will give anything (monetary or otherwise) in order to be with you, be seen with you, be close to you, and hold some part of you- even if it's just a moment or two of your time. Fans see that there is competion for your attention and affection as well. They constantly try to stand out/above others in your 'fan club' so that they can be considered a favorite of yours, making them the 'prize winner' and all the more special (to themselves and to the other fans who become jealous of favorites, and to you as well).


One more dimension that AliceWonder notes about fans is that “every step of the way, I was just being me and they liked whatever it is they saw, and they wanted to tag along.” (2011).


I would like to turn briefly to meta ethics because Charles Stevenson notes that those of “forceful personalities issue commands which weaker people, for complicated instinctive reasons, find it difficult to disobey, quite apart from fears of consequences” (1937). He also writes that the “emotive meaning of a word is a tendency of a word, arising through the history of its usage, to produce (result from) affective responses in people. It is the immediate aura of feeling which hovers about a word. Such tendencies to produce affective responses cling to words very tenaciously. It would be difficult, for instance, to express merriment by using the interjection ‘alas’ Because of the persistence of such affective tendencies (among other reasons) it becomes feasible to classify them as; ‘meanings’” (1937).


Before moving on to the specific HPD symptom that might prove to be the most difficult to manage, I will summarize what all this information means: AliceWonder, notes that there are people in their life that know that forum poster is dangerous but because Alice Wonder is “just being,” they “tag along.” This ‘tagging along’ gives AliceWonder worth. Now, Stevenson was not a psychologist, he was a philosopher, but he notes that “forceful personalities issue commands which weaker people, for complicated instinctive reasons, find it difficult to disobey, quite apart from fears of consequences” (1937). He also notes that the “emotive meaning of a word is a tendency of a word, arising through the history of its usage, to produce (result from) affective responses in people. It is the immediate aura of feeling which hovers about a word” (1937). All of this together suggests that people with HPD for whatever reason are emotive, but not actually emotional. To clarify this point, HPD emotions are shallow and often shift rapidly; may alienate friends with demands for constant attention. The notion that their emotions are shallow is in line with the idea that the emotive meaning of a word is its tendency to produce affective response (1937).


This might ensure that emotions being pathologically shallow would prove to be the most difficult symptom of this disorder. To exist in the world in a state where every word and every action potentially lacks sincerity is for me reflective of the raw depth of why this personality disorder is at the end of the day cleanly a disorder and a disorder that would be difficult to have. Before turning to ideas about treatment options, I want to illuminate the severity of pathological shallowness.


Stevenson notes that “[when] we ask 'Is X good ? ' we don't want mere influence, mere advice… We want our interests to be guided by this truth, and by nothing else. To substitute for such a truth mere emotive meaning and suggestion is to conceal from us the very object of our search” (1937). Stevenson is referring of course to the supposed moral quality of something (like law) being considered by someone but consider that notion in the frame of HPD: when we ask, ‘Are the words and actions of X sincere?' we don't want their magnetic quality to answer… We want the answer guided by authenticity, and by nothing else.


The propensity of people with HPD to exist in a perpetual state of magnetism is because their self-esteem and sense-of-self is damaged. Their shallowness and attention-seeking behavior reflects an irrational, distorted self-image that is ceaselessly dependent on the approval of others.


A potential treatment option of this disorder might be through Albert Ellis’s unconditional self-loving strategy in his rational emotive behavior therapy, or REBT. If Carl Rogers is like a plant bringing oxygen to the mental health community, Ellis is like a mushroom bringing a gallows humor or dark comedy version of humanism to the mental health community. Given that The GroundUp also compares itself to a mushroom, this is a clean marriage in the dirt.


Ellis not only encourages mental health professionals to literally be unlike Rogers and teach people with personality disorders (meaning, don’t let the personality disordered patient run the show and also maintain your dignity and do not allow yourself to be seduced to send your money to them or something like that) “how to unconditionally accept themselves” (1994). REBT is interesting in that it takes personality disordered people away from the obsession with being flawed in the conditional framework of ‘Yes, I have personal worth if X’ or ‘No, I don’t have personal worth because Y’ by encouraging people to “choose to only rate or evaluate their thoughts, feelings, and behaviors and not fall into the dangerous error of rating or measuring their self, their essence, their being, or their totality” (1994). The rationality of REBT is that no one “can substantiate or falsify [their] view of human [and therefore personal] worth” (94).


Earlier, I noted that this disorder has some upsides because even though a person dealing with HPD may lack sincerity, they still say more than some people with ASD who may only say ‘Yes’ or ‘No.’ Though, a person with ASD with seemingly singular and obsessed focus may have a firmer sense-of-self than a person with HPD and they might not be as dependent on the validation of other people. The average person with HPD likely has more friends than the average person with schizoid personality disorder, or SPD. However, a person with SPD may be seen as more sincere. What this means is concomitant with the idea that there isn’t a hierarchy of disorder, there is simply disorder.


Cognitive therapy and psychotherapies like REBT that avoid measuring the self are treatments capable of treating this specific disorder because a cognitive therapist can help a client recognize dysfunctional ideas, challenge catastrophizing thoughts about themselves and their situations and find a more positive way to view things. Ellis notes that REBT can help all personality disorders (1994), but he ultimately focuses his 1994 research on borderline personality disorder, or BPD, which is in the same cluster (B) as HPD.


Now, as with any mental health treatment, it's important to remember that REBT and its likenesses may not be equally effective for everyone and each individual's treatment plan should be tailored to their specific needs and circumstances. And this is exactly why mental health care needs to be personalized and comprehensive, and it should ideally include psychological, social, and medical interventions.


Yes, another marriage that needs to occur is the marriage of the medical model and institutional models with the hippy dippy models. The Dharma & Greg model if you will. Father and Mother.


Too many of the hippy dippy models treat mental illness as this Natasha Bedingfield lyric masturbation that enables dark shit. The medical model of course used to put people in straitjackets. The solution must be to wage war for the improvement of mental health.


People with mental health disorders should know that wherever they turn to there is a trained mental health professional in a fully operational and fully supportive facility whether it be in patient or out patient that is linked to its opposite for a nuanced solution.


And while The GroundUp is not made up of medical professional, we would like to explore a therapeutic approach that inpatient and out patient facilities may utilize in different ways: Therapeutic Empathy Transformation (TET).


This approach would merge concepts from various therapeutic modalities, primarily cognitive-behavioral and psychodynamic therapies, while emphasizing the importance of authentic emotional expression and the transition from superficial emotive reactions to deeper emotional understanding and communication and the transformation of dark behavior through empathy, acceptance and personal growth.


Below are steps of the proposed model:

  1. Initial Assessment and Building Trust: The first phase would involve creating a safe and non-judgmental space where the individual feels comfortable sharing their experiences. An initial assessment would help understand the individual's history, current struggles, and behavioral patterns.

  2. Safety and Contingency Planning: Given the depth of emotional exploration involved, it might be helpful to establish a contingency plan at the onset, which the individual can utilize in times of extreme emotional distress. This could include crisis numbers, a list of supportive individuals to reach out to, or grounding exercises that the individual finds effective.

  3. Involvement of Supports: If the individual is comfortable with it, involving significant others or supportive figures in certain parts of the therapy might be beneficial. They can provide additional perspectives and also learn ways to support the individual outside of therapy.

  4. Shadow Exploration: This stage focuses on exploring the "shadows," the pain and experiences underlying the individual's actions. This could involve examining past traumas, attachment issues, unmet needs, or other relevant experiences.

  5. Emotional Processing: Encourage individuals to fully experience and express their feelings about their past and present experiences, allowing for processing and emotional release.

  6. Darkness Exploration: This stage creates an atmosphere to mirror the darkness of a patient (this stage involves acting).

  7. Reflection and Processing: The client observes their darkness mirrored back at them, potentially gaining new insight and perspective. The therapist assists in processing these insights, ensuring the client doesn't become overwhelmed by the experience.

  8. Therapeutic Grounding: The session concludes with grounding techniques to ensure the client returns to a safe emotional state before leaving the therapeutic environment.

  9. Cognitive Reframing: This phase involves challenging and reframing negative or destructive beliefs the person holds about themselves or others. This is a crucial step in transforming perspectives and promoting healthier thought patterns.

  10. Empathy and Understanding: Foster a deep sense of empathy and understanding, helping the individual see that their actions, while harmful, have origins in their pain and suffering. This can help reduce self-stigmatization and create room for self-compassion.

  11. Skills Training: Teach practical skills for managing emotions, improving interpersonal relationships, and making healthier decisions. This could include assertiveness training, stress management techniques and problem-solving skills.

  12. Transformation and Integration: The final phase focuses on transforming the individual's understanding of their behaviors and integrating new, healthier ways of being into their everyday life. This involves creating a personal growth plan and setting achievable goals for the future.

  13. Maintenance Phase: Focuses on reinforcing the changes made during therapy and managing any potential relapses.

  14. Follow-up and Support: Regular follow-ups would ensure that the individual is maintaining their new patterns of behavior and would provide additional support or interventions as needed.

  15. Evaluation of Therapeutic Outcomes: Regular evaluation of therapy outcomes can help determine the effectiveness of the therapeutic process for the individual and make necessary adjustments.

This is an extremely sensitive process that could potentially be quite powerful, but it requires a high degree of therapeutic skill and sensitivity. For example, the Darkness Exploration would be a step further than Carl Rogers' "empathetic understanding," in which the therapist seeks to understand the client's perspective as deeply as possible. In this model, the therapist would not only understand but also reflect or embody the client's darkness in a controlled manner. There is a risk that the immersion could potentially become retraumatizing rather than therapeutic, and such a method would need to be used with great care and caution.


Different facilities could offer different solutions for immersion but ultimately through a controlled therapeutic environment, trained therapists would act as mirrors, allowing individuals to observe and reflect upon their behaviors from a new perspective. This process encourages deep self-reflection, helping individuals gain insight into the underlying causes and motivations behind their actions. By acknowledging the darkness within, individuals are empowered to understand the origins of their behaviors without condemnation or judgment.


This therapeutic approach embraces the complexity of human experience, recognizing that darkness is a reflection of unmet needs, past traumas, or distorted self-perceptions.


By providing a safe container for exploration, individuals are encouraged to confront their shadows and integrate these aspects into their overall understanding of self.


This innovative approach combines various therapeutic techniques, including emotional processing, cognitive reframing, and skills training, to support individuals in transforming their behaviors and fostering personal growth. It emphasizes empathy, self-compassion, and the development of healthier thought patterns, enabling individuals to break free from destructive cycles and embark on a path towards positive change.


In conclusion, our exploration of mental health, reinstitutionalization, and therapeutic approaches has led to a reconsideration of the The GroundUp's stance on the aspiration, hope and ideal condition for dealing with mental health issues.


While hope remains a powerful motivator for change and betterment, it is essential to acknowledge the complexities involved. To reiterate, The GroundUp does not endorse a "Dandelion Insurrection" approach that disregards the dark realities of the world solely based on a person's identity. Instead, our project, Research On Ethical Reinstitutionalization & The Indignity Of Mental Illness Normalization, aims to foster a better understanding of the "is" of mental health and strive for what ought to be—an inclusive society that provides proper care and support for all its members.


Reinstitutionalization is a complex matter that requires careful ethical considerations.


While it can be a necessary option for individuals who have no other place to go, it should not become an excuse for neglecting the overall mental health of the population. The primary concern should always be to uphold the dignity and rights of individuals with mental health conditions. Unchecked reinstitutionalization could lead to abuses and violations of these rights, which is why a comprehensive approach is necessary.

Deinstitutionalization, though initiated with good intentions, has faced challenges due to the lack of community services and support systems. Housing challenges, increased homelessness and incarceration rates, stigma, co-occurring disorders and the lack of continuity of care are just some of the issues that persist. Therefore, it becomes apparent that reinstitutionalization to a certain extent is necessary. However, the question remains: to what degree and extent?


To address these challenges, it is crucial to consider important perspectives, such as public safety, evidence-based treatment, social integration, and policy and funding. By striking a balance between the rights and needs of individuals with mental health conditions and those of society as a whole, we can work towards a more comprehensive and effective mental health care system.


Moreover, our exploration delved into the complexity of histrionic personality disorder (HPD) and its challenges. While individuals with HPD may possess persuasive qualities and an ability to enamor others, their shallow and attention-seeking behaviors can pose significant difficulties. Pathological shallowness, in particular, presents a profound challenge as it hinders authentic emotional expression and sincerity in interpersonal relationships.


In this context, therapeutic approaches such as Therapeutic Empathy Transformation (TET) offer promising avenues for treatment. By merging cognitive-behavioral and psychodynamic therapies, TET focuses on authentic emotional expression, deep self-reflection, and personal growth. It aims to transform destructive behaviors through empathy, acceptance, and the development of healthier thought patterns.


However, it is essential to emphasize that TET, like any therapeutic approach, should be applied with caution and tailored to individual needs. The immersion and reflection process must be conducted with sensitivity to avoid retraumatization and ensure a therapeutic experience. By integrating innovative approaches like TET with comprehensive mental health care, we can address the unmet needs of individuals and promote positive change.


Our journey through mental health, reinstitutionalization, and therapeutic approaches has underscored the importance of a comprehensive and personalized approach to mental health care. By striving for an inclusive society, upholding human rights and combining different therapeutic modalities, we can create a safer and more compassionate world for individuals with mental health conditions.


Let us continue to advocate for improved mental health care, personalized interventions, and a holistic understanding of mental well-being. Together, we can break free from destructive cycles and pave the way for a brighter future.


References:

AliceWonder. (2011). Why we Have our 'Fan Clubs' (for HPD's ONLY) [Post in the histrionic personality disorder forum on Psych Forums]. Psych Forums. https://www.psychforums.com/histrionic-personality/topic66338.html


Ellis, A. (1994). The treatment of borderline personalities with rational emotive behavior therapy. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 12(2), 101–119.


French, J.H., & Shrestha, S. (2022).


Histrionic Personality Disorder. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK542325/


Stevenson, C. L. (1937). The Emotive Meaning Of Ethical Terms. Mind, 46 (181), 14-31.





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