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Transcript for November 2013

>> Okay. Well, I'd like to thank you for coming to today's presentation of about the recovery model, and I wanted to thank Interwork and Chuck and Marge for having me come. I'm really excited to be here. My name is Sarah Hancock, and I am a recent graduate of San Diego State University's rehabilitation counseling program. Yay! And, so, I have my masters in science, and I also have certificate in psychiatric rehabilitation. It was a fun process, and I'm so happy that it's over. No, I'm just kidding.

[ Laughs ]

Okay. Well, I'd like to tell you a little bit about me. I'm Sarah. I'm a third generation San Diegan. I got my -- I have a sense of humor. This is from an e-mail that Chuck sent me regarding a grade. Yeah.

 

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[ Laughs ]

>> I didn't say that!

>> Just kidding. Okay. I make jewelry. I'm an author. I have my own column about psychiatric recovery, and this is my family. I married the man of my dreams two years ago, and I've got -- I inherited four amazing teenagers. Graduated from San Diego State. Graduated from Brigham Young University, and this you might not be able to see but it's a picture of Napoleon Dynamite sporting my alma mater's t-shirt, Ricks College, and it's now a four year school, BYU Idaho. So, that kind of gives you an idea of who I am as a person, and -- let's see. But I'd like to give -- I'm going to put you in charge of advancing. I'd like to you give an understanding, a little bit more of an understanding, of what it's kind of like to walk in my shoes, and to do that, I'd like to go over this poem that I passed out to everyone. Do you have a copy of it? Rachel, I believe it's at the top paper on the -- there you go. Okay. So, Marge, would you do the honors of reading the "if you are" statements. Just a second. We've got to get you a microphone. Okay. Speak loud.

[ Laughs ]

 

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Okay. Okay. Sounds good. Thank you.

>> If you are overly excited.

>> You're happy.

>> Oh, I'm supposed to do the "you" statements.

>> Yeah. Yeah.

>> Oh, okay. Why can't we reverse it?

>> Okay. We can.

[ Laughs ]

We can do it. We can do it reverse. We're going do it reverse. Okay. If you are overly excited, you are happy.

>> If I'm overly excited.

>> I'm --

>> Oh, we read the whole thing. We're not alternating.

>> We're reading the whole phrase.

>> She didn't give me instructions!

>> Okay. Let me try this again.

>> Okay. We're going to read the entire phrase alternating back and forth between the "you" statements and the "I" statements to give you a better understanding of the differences, perhaps, between you and me.

 

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>> Got you!

>> Okay. Marge, thanks for being my guinea pig.

>> If you are overly excited, you are happy.

>> If I am overly excited, I am manic.

>> If you imagine the phone ringing, you are stressed out.

>> If I imagine the phone ringing, I'm psychotic.

>> If you are crying and sleeping all day, you are sad and need time outs.

>> If I am crying and sleeping all day, I am depressed and need to get up.

>> If you are afraid to leave the house at night, you are cautious.

>> If I'm afraid to leave the house at night, I am paranoid.

>> If you speak your mind and express your opinion, you're assertive.

>> If I speak my mind and express my opinions, I am aggressive.

>> If you don't like something and mention it, you are being honest.

>> If don't like something and mention it, I am being difficult.

>> If you get angry, you're considered upset.

>> If I get angry, I'm considered dangerous.

>> If you overreact to something, you are sensitive.

>> If overreact to something, I am out of control.

>> If you don't want me -- if you don't want to be around other people, you are taking care of yourself and relaxing.

>> If I don't want to be around other people, I am isolating and avoiding.

>> If you talk to strangers, you are friendly.

 

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>> If I talk to strangers, I am inappropriate. For all of the above, you are not told to take a pill or are hospitalized, but I am. Thanks, Marge. This poem is actually a very accurate description of the past 15 years of my life, and interestingly enough, I've finally come to grips with it. This poem was written by a woman named Lisa Saint George who is one of the leaders in the Recovery Survivor Movement. She actually works for an organization called Recovery Innovations. Sorry. Recovery Innovations, and if I were you, if you provide services for someone who has, like, a psychiatric disorder, if you have a loved one or a family member, or if you struggle with some kind of diagnosis or thinks maybe you might have a diagnosis, I would look up Recovery Innovations. They have amazing classes. One of their classes is a wellness recovery action class, plan class, which helps people with psychiatric disorders recognize their triggers, recognize those things that they need to do in order to stop their triggers from escalating into something more serious. They also treat, they also teach a class that's called their "well class". Basically, it's teaching people the principals of wellness and how the create wellness within their own lives, and they also teach a class that's called a "pure education training class". And this class is actually a 75-hour certification program for people who have severe mental illness who are interested in becoming supports and mentors for their peers. So, it's a really excited program, and they're very serious about it. If you miss, I think it's more than eight hours of that class, you are dropped, and if you want to take the class again, you have to start over from the very beginning.

 

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And, so, you know if you have the opportunity to work with peer support specialist who's gone through this program. It's developed standard in San Diego as far as the peer support specialists are concerned. Okay. I'm ready. Okay. So, let's look at the medic model here. A lot of us are familiar with the medical model in terms of diagnosis, in terms of treatments, this is the newest version of the DSM. I put this picture on here because it's a photo I sent to my doctor who was giving me shock treatments at the time while I was asleep. I asked him if he wanted, I could order him one, and I think the irony of it was that it's for exterminator, but that is kind of what I felt like when I walked past the truck. I'm like, oh, yeah. That's what my doctor does to me. He zaps me while me while I'm napping. I've been in a strait jacket for more than 36 hours, actually, and I've been on more than 37 different combinations of medications. However, in taking the medication, in being hospitalized, in doing all those things, I was very compliant. "Compliant" is something that they use when a patient is doing exactly those things that they're told to do and I did that because I wanted to get better, but I got worse. And, so, in terms of living with severe psychiatric disorder, I couldn't figure out what I needed to do to move forward because the things that the doctors were telling me, all you have to do is just have your CTU, you'll get better. Just take your medicine every day, you'll get better. But I wasn't getting better. In fact, I was getting worse. Okay. Next. So, through the medical model. This is what I'm known as. This is the code from the DSM, 295.70, in parenthesis with an S25.0. I have schizophrenia, or schizoaffective disorder, bipolar type, which is a combination of aspects of schizophrenia, so my mind can play tricks on all five of my senses. And it's also bipolar disorder, so I get the mood roller coaster too. And in 2002, I was actually catatonic, so I have this extra code for catatonia. And that's all I am from the medical model. A bunch of numbers and a diagnosis. And I'll argue that, as we worked together as rehabilitation counsellors, there's more to people than the number. And not only that, it's our objectives to help them discover that. Beep.

 

 

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[ Laughs ]

Okay.

>> Sarah?

>> Yeah?

>> I'm also following a couple people online.

>> Oh, okay.

>> I told them that if they have questions then I'll, like, raise my hand.

>> Perfect.

>> Ask a question [inaudible].

>> And this is meant for, to be an open dialogue, so if you have any questions at any time, please, don't hesitate to raise your hand to ask a question. That's what we're here for. So, when I was very first diagnosed, you know, I was sad. I just got back from a mission serving for her church, learned how the speak fluent Spanish, I was an interpreter in American Sign Language as well, I loved mountain biking, I was enrolled at school at Burgeon Young University, I had a lot of friends, enjoyed life, I was engaged to get married, and my fiancé broke it off two months before when we were going to get married. And for whatever reason, be it genetics, because I do have some family members who have bipolar disorder, I don't know where this schizophrenia aspect of it comes in, but it was enough to push my emotional and mental capacity over, into overload and that's when I had my very first psychotic break. So, I walked into a hospital as a whole person. Beep. And, then, I was given a diagnosis, and initially, my diagnosis was bipolar disorder. And I was in the process of learning how the deal with the symptoms, learning how to get adjusted on the medication, learning how to get balanced, and unfortunately, we can't show you the animation of this, but this condition became all consuming. It was like it just spread out. And, so, no longer was I the same person I was I walked into the hospital. Little by little, I began identifying myself as my diagnosis. So, I notice the same thing happened to other people as well. For example, when I worked at the corner clubhouse, it's a clubhouse model, we never discuss diagnosis. However, when we'd have a new member come in and introduce themselves, they'd be like, oh, hi. I'm George, and I have schizophrenia. Not, hey. I'm George, and I like to ride motorcycles and I like to go kite flying and, oh, I like my cats. It was just their name and their diagnosis, and I can see that the same thing had happened to them as well. Their condition had become all consuming. So, that brings us to the next question. What's recovery? Mike, would you mind reading this quote? Can you --

 

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>> The entire thing?

>> Just the top.

>> Rather than focusing entirely on the amelioration of psychiatric symptoms for those with severe mental illnesses, viewing individuals through the lens of the recovery model. A system in the development of goals and skills allowing people to maximize their potential.

>> So, medical model focuses entirely on, you know, take the medication, your symptoms will get lessened or control your symptoms. So, in your eyes, how is this different from the recovery model? Excuse me. How is this, how is the recovery model different from the medical model? Gosh. Silence fills the air. Rachel? Rachel, how is it different?

[ Inaudible answer ]

Exactly. So, for those of you who couldn't hear, the medical model's kind of a Band-Aid. You know? It works pretty good for a bit, but if you put a Band-Aid over a cut artery, how much is it going to help the person? Not very much. But like Rachel said, the recovery model emphasizes that there's more to a person than simply their label and that they do have infinite potential. Jack, you had a question.

 

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>> This is from Sarah Carter.

>> Oh, okay.

>> She says, the recovery model focuses on the whole person and their strengths, rather than just a diagnosis.

>> Yeah. Perfect, class. Good answer. You're right. It does. So, an interesting aspect of this for me as I've gone for 13 years without really moving forward in getting better and basically losing my identity, when I took the peer education training class and found this quote in their handbook, my jaw hit the floor, and all of a sudden, I understood what recovery was. Would you mind reading that?

[ Inaudible response ]

For me, that statement was a lightning bolt. All of a sudden, I was like, yeah! You know what? My illness is not my entire, you know, who I am. Yes. It's an aspect of me, but it's not who I personally am. Beep.

>> Also, Lisa Hurley.

>> Hi, Lisa.

>> And it's based on hope as well.

>> Yes. It is based on hope. We'll get into that. Okay. So, perhaps you're wondering where does the recovery model begin? The recovery model isn't something you're going to find in your textbooks because those textbooks were written by theorist and academics, but the recovery model is actually a grass roots movement that was started by people with psychiatric disorders. And at that time, and I totally appreciate this title, they were calling themselves "psychiatric survivors", and, so, they termed the Psychiatric Survivor Movement. These were the people who had been diagnosed with an illness; had lived in psychiatric asylums; had -- in it will 1970's, they'd been released from psychiatric asylums without really any training as to how to rent a house or get back in the community; they were used to living in an awful situation, suddenly, they were given freedom, but they didn't really know how to take advantage of it. And, so, a lot of these people got together, and in New York, after the deinstitutionalization of the huge mental health asylum in New York, a lot of them got together in New York City and created what's called the "Fountain House". If you're not familiar with what a clubhouse is, I would encourage you to write that down, something that you can look up, because the clubhouse is a psychosocial rehabilitation facility, and it's perfect for any of the people that you serve who have a psychiatric disorder. Clubhouses have work ordered day. They have classes, both vocational classes, social skills classes. They have, I know at the corner clubhouse, we would have, when people give jobs, like sweeping the floor, cleaning out the bathrooms, serving lunch, they would get points, and, then, they could use those points to buy things within the clubhouse. It really was an awesome, awesome model, and it's actually, there's an international code for the clubhouses. It's not just something in New York or here in San Diego. In San Diego, there's actually 15 clubhouses, and they cater to all different populations. If you're deaf, there's a deaf clubhouse. If you're transitional aid youth, you know, 16 to 25, there's a clubhouse specifically for that population. If you're from the orient or you're of Asian descent, there's a clubhouse for that population as well. They're all over San Diego. Beep.

 

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>> From the --

>> Oh, yeah.

>> Comments.

>> Comments!

>> Sarah Garner says, Sarah, that's a beautiful picture that your husband took. Lisa Hurley says --

>> Thank you.

>> Does the clubhouse have the gavel club as well?

>> Yes. The gavel club is actually a A younger model of the -- what's that called? Lisa, help me. Toastmasters! So, for the gavel club, you don't have to pay the dues to be in Toastmasters, but the gavel club is wonderful because it helps people in the clubhouse -- they have a, like, normally, they have them in high schools and such, but in the clubhouse, it helps people who have an access one diagnosis learn how to present themselves, learn how to speak in front of other people, learn how to present their ideas in a format where they're more fluid and be able to present them in a way that other people will be able to listen and understand. Okay. So, what is the recovery model? It is okay if we just bounce back from person to person? Come around here and read what the recovery model is.

 

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[ Inaudible response ]

No. Actually, let me do this a little bit differently. This is a new slide, so I'm not used to it. But in our research about the recovery model, I learned that there are several different models that people have published explaining different aspects of the recovery model, and the very first explanation of what the recovery model is was written by Young and Essings [phonetic], and these people are academics. They wanted to figure out, you know, what does it mean to get into recovery? What -- how are the people, how the consumers defining this progression for recovery? And, so, this is the topic, these are the things that they come up with: Overcoming stuckness, developing and fostering self-empowerment, learning and self-redefinition, returning to basic functioning, and improving quality of life. And it's interesting because later a women named Pat Vegan who has a diagnosis of schizophrenia and also has her PhD, she wrote another article that embodied different terms for the steps through the recovery model. And, then, Anna Smith is actually the author of the article that I gave you in your handouts. I personally like this article because it's someone who is actually in recovery who's also a professional, and so she's able the take these terms that professionals use and put them into the explanation. She's able to take the terms that the consumers use and put them into the language of the academics and those who provide services, helping them recognize that it really is a real model and it's valid. Okay. Next. Okay. Marge! Help me! What does the recovery model focus on?

[ Inaudible answer ]

 

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This is the foundation for the recovery model, and I think the last one is really important. Trained peer support. The reason I feel that this is really important is because as a peer, I would go to these partial hospitalization programs meant to augment my treatment, and I'd go and sit there with a group of other people who had a severe diagnosis, and, there, we would go around the room and check in and we'd go around the room and discuss what's going on. We'd go around the room and cry, and, then, I'd walk out with a heavier load than I'd walked in with. I didn't feel any better, in fact, I would dread going to the program because I was having a hard enough time struggling with my own issues. Hearing about everyone else's was just overwhelming. I hated it. But I had to go because, in my mind I thought, well, my doctors are telling me that this is going to help me so I'd better go because I want help! [inaudible] peer support, like I discussed earlier with Recovery Innovations, that certificate program, I mean, other states actually have licensure for trained peer support. Georgia was the first state to have a state licensure for peer support. In the class that I took, I learned how to share my experience appropriately, and others that was talking to, we learned how to take the strength that we've gained from experiencing the severe psychiatric disorder and help other people grab on to that strength. Sometimes we're just holding their hope for them as we're telling them things can get better.

 

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There is a light at the end of the tunnel and it's not a train. I promise. Okay. So, Lisa, this is exactly what you were talking about. Okay. So, we have the foundation, which was the previous slide, and these are the pillars. We just build it with recovery. So, hope is vital. When I very first was diagnosed, I was like, okay. Well, I just, you know -- I'm in the hospital now. I just need to act right and put my smile back on and get out and go back to school and I will be fine. But as I kept going and as my moods got more and more disregulated and as my symptoms starting popping up and becoming the focus of my life, slowly, my hope was just deteriorating. I couldn't see how I could wake up at a regular time because my medications were causing me to sleep 18 hours a day. And when I wasn't asleep, it was because my eyes were open, it wasn't because I was processing the information. So people around me started treating me different. Oh, yeah. Sarah's lazy. Sarah doesn't do what she needs to do to get better, and, suddenly, people are looking at me saying, well, it's because you're bipolar. Oh, it's because you're schizophrenic. You know, all of these terms that were being used on me, and little by little, those who surrounded me, whom I previously looked at my supports, they were helping me eat away at my hope, and it was hard. And I think as people come into our offices, as rehabilitation counselors, we have to, on some level, assume that they need hope. Not only that, that we need to be the person to hold their hope until they can take it and move forward. Beep. Okay. So, like I said, I struggled with my illness for about 13 years. And in 2009, I had had enough.

 

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I took my life into my own hands, and previously, I'd been kind of, yeah, well, you're sitting in on your treatment plans. You're making your own goals, but I wasn't really progressing. So, even though I had the goal, I wasn't really -- I didn't know how to achieve it. I didn't know how the break it down into smaller things and because of that, people were looking at my goals and they're going, oy, talk about grandiose. Sarah thinks she can go back to school and get her masters. She can't even get out of bed in the morning! Oh! Sarah! Sarah wants to write a book! She can't even form a sentence! Oh! Sarah wants to have a family, wants to be in a relationship, but her moods are out of control. Who wants to be married to her? You know? And, so, I had lost myself. But, then, I started thinking, okay, so, this isn't working. What can I do? The very first thing I did was figure out how I can get out of the abusive group home I was in. Gratefully, a loving woman invited me to move in with her, she was a mom of a friend in high school, and I moved in with her. It was against my doctor's advice, it was against my parent's, you know, parent's interest. I even had previous roommates who were calling saying, "Don't let Sarah move in with this lady because she was the worse roommate ever! I don't anyone else to go through that!" And this woman was like, I don't care. And I was like, bless you!

 

 

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[ Laughs ]

So I moved in with her. And, then, I was in a situation where At the move, I would no longer have a ride to get ECT, which were the shock treatments, and I said, "Yes! I'm quitting." I tried to quit earlier, and the last time I had gone in, my doctor, I told my doctor I wasn't going to do it anymore and my doctor said, "Well, we need to talk about it. Just come into the room. Come in the room." And, so, I came in the room, and then, well, there's no place to sit. Why don't you just sit right here on the bed. Okay. Sitting on the bed. They're talking to me. You've got to do this, you know. You're completely unstable. This is going to help you get better. I told them I wasn't interested, and before I know it, I was strapped down, and they were handing me the consent form and forcing me to sign it. And they did that. And I had my last treatment, and I was determined I would never go back. I would never have it. Against my parent's desire, against my doctor's desire, I was like, forget you! I'm taking control. That hasn't helped me. I'm not going to keep doing it. That was my experience with ECT. I have actually a family member who has a completely different experience with ECT, but I'm just telling you about my experience with ECT. Questions? Okay. So, as I moved in with this lady, she's asking me, well, what do you like to do? I don't know. I'd been so stuck in group homes, in the hospital, in the institution, for so long, I'd forgotten. Well, I like to read, but my brain is completely fried from my shock treatments and I can't even remember a sentence, a line to figure out which lines the next line.

>> Lisa Hurley had mentioned, when you talked about the consent form, she says, then, it really isn't an informed consent since they did not let you know about the potential for permanent brain problems. And, then, Sarah said that's an excellent point, but --

 

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>> Yeah, it is. Because they don't. They don't completely inform you. Okay. So, I started redefining myself. What do I like? Where do I want to work? What do I want to do with my life? Who do I want to be? And, suddenly, my condition became this part of my life, and I started figuring out, what are my dreams? I have always wanted to get my masters in rehab counseling. I do have a family. We're not on the best terms right now, but they're still my family and I'd like to be on better terms with them. I've got a culture. I'm a member of a church that I absolutely adore, and I really feel supported by and we have red punch, white cookies, and mint candies and all the good.

[ Laughs ]

And I find peace through the knowledge of God. And, then, so, I started reexploring all of these aspects in my life, and suddenly, I was rediscovering who I really was. Beep.

[ Laughs ]

So, the second key to recovery is, all together. [inaudible] Yes. [inaudible] accountability. Now, it's interesting because in the things that I've read, they've talked a lot about how important choice is. How it's important for the client to have choice in their treatment. How it's important for the client to make the decisions in their own care. But I'd like to extend it beyond care, beyond treatment plans, because often times in my personal life, as I was struggling with my illness and doing things, my family wasn't holding me accountable for my actions. Some of my actions were way out of control because of my illness, but I wasn't even being held accountable even in the most minute part. I went on a huge shopping spree, ended up in the hospital because I was so manic, and my loving father gathered all the things that I'd bought and slowly went around each store and returned them. Saving my credit, saving me, saving my face, you know, saving all that, but not holding me accountable for what I did. And it wasn't until my dad lost his job, so he was no longer able to provide the room and board to take care of my needs, that I suddenly was being held accountable for those things that I did. Suddenly, I started getting called from the credit card company. Yeah. You haven't made a payment in four months, and you owe us a lot of money.

 

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These people are calling me, calling me, calling me, all hours of the day trying to get their payment, and for the very first time, I was being held accountable for something I had done. Not saying that I never was held accountable for anything else in my life, but it was a wake-up call for me And there is dignity in failure. Does that make sense to anyone? Does anyone have a question about that? There is dignity in making a goal, reaching for it, and falling flat on your face because at least then you can say, I reached for it. There is dignity in failure. Beep. So, the third key or pillar to recovery is empowerment. When I suddenly decided, you know what? I'm out of here. I'm moving out of this group home. I'm stopping ECT. I'm going to find a job. I'm going to make my own money. I'm going to move forward in life. I'm going to try going to school, try enrolling in a graduate program, try finding some kind of financial support for that, try, try. Suddenly, I'm realizing, hey, you know what, Sarah? You can do a lot more than you've thought you could for the past 13 years. You could do a lot more than what other people expect of you, and that was exciting. I started my program here, and I'm sitting in Marge's class. I'm sitting in Jeff's class, and I'm making comments, you know, because I have a big mouth and I make lots of comments. So, people were coming up to me afterwards and they're asking me, where do you work? You have so much experience in this. That's just amazing.

 

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I mean, tell me about your background. I'm like, oh, you know, I know many people with psychiatric disorders. It was really interesting, and suddenly, my classmates and my professors are acknowledging that the experience that I have is valid. Not only is it valid, but maybe it can be used to help other people. And for the first time in my life, my illness is not a weight around my neck. It's like a glitter you pin on my shoulder. That was empowering. Beep. So, I know you guys are all thinking -- did you have a question, Rachel? I know you guys are all thinking, so, how can I help empower other people? So, I want you to write down and look up a WRAP plan. A WRAP plan is an acronym for wellness recovery action plan. As a person creates their WRAP plan, suddenly, they're shifting their focus from mental healthcare, from symptom control, to living life, and preventing symptoms before they even happen, and I have made a WRAP plan twice. The first time I made a WRAP plan, I made it with my counselor in a group of non-trained peer support. We all were sitting there, kind of looking at each other. We were all severely ill, so Kaiser put us all together in this little group, and they were all kind of scratching our head, staring at each other for the answers. So, they'd say, well, what are you like when you're well? I don't remember. I haven't been well in a very long time. Well, what does your family say about you? Well, my family kind of twerped that I'm so sleepily, not going chores and stuff. And, so, this counselor was trying to feed us, okay, well, do you have a smile on your face? Do you take a shower on the regular basis? And, so, she's asking all these questions, and I'm going, oh, yeah. Okay. That was my experience the first time I took my WRAP, I made my WRAP plan. Then, I made a WRAP plan with a peer support specialist.

 

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When I sat down in that room, I can feel something distinctly different. It wasn't a darkness. It was an energy. And in that plan, in that class, we were all sitting together, and I started asking people, the peer support specialist is saying, what works for you? Or what are some things that haven't worked for you but might work for someone else? And I'm thinking Well, I can tell you a lot that doesn't work for me, so maybe it will help someone else, maybe not. And, so, I'm feeding people answers. My thing was I have a hard time getting to sleep at night. Unless my husband hits me over the head with a two by four, I do not fall asleep. Gratefully, two by fours are not allowed in our apartment. But my counselor had always said, well, take a nice hot bath. For me, taking a nice hot bath is like watching a hard boil, or an egg become hard boiled. I hate sitting in hot water. I don't even like Jacuzzi's or spas. I don't like to sit in there because I truly feel nonproductive. I just, I hate every ounce of being in a bathtub. So, my counselor was like, everyone loves relaxing in the bathtub, you should write that down as a WRAP on your WRAP plan, and I'm going, no, no, no, no, no! But I'm sharing this with other people. Oh, my counselor said maybe if you take a bath, and someone's like, oh, I like taking baths. I'll write that down in my WRAP plan. Later, I was discussing in the group, I'm really triggered by a lot of noise. When there's a lot of noise, I can feel my entire brain just shutting off for whatever reason. And my parents, because I would go to these huge family events, I'd be gone for three, you know, an entire weekend at a huge family event with 45 people, and every single time I'd come home into the hospital. And my parents are thinking, well, she can't enjoy stimuli and she can't be with the family and we need to keep her home and not enjoy it.

 

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But I'm telling them about this trigger with lots of noise, and one of the people in my WRAP class, says, oh, I have the same problem. I use ear plugs. Duh! I'd never even thought of that. So, I go to the next family activity and I've got my fancy little plastic rubber ear plugs, and I come home from the activity and I don't go to the hospital and my parents are asking each other, what's going on with Sarah? We're just kind of waiting to check her in, and I'm going, wonderful! Let's go have fun! This is awesome! I had so much fun with my family! Yay! It was really interesting. It was completely different experience and that's kind of what creating a WRAP is. People brainstorm with each other and they come with ideas, not only to help other people, but to help themselves. I was coming back the next week for the WRAP class, and people were saying, "Oh, you know that thing you tried that didn't work for you? It worked for me! Thank you so much for telling me about it." And I'm going, oh, my opinion was valid. That's kind of cool. I helped someone. That's really cool. Okay. If you want more information about the WRAP plan, you can either Google Mary Ellen Copeland who is the woman who created it on a -- she's done more research on this, and she is someone who has a diagnosis. And, then, teach the people that you work with about local community resources. Just to name a few there's, like I mentioned before, 15 clubhouses in the area. Many have classes.

 

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They have support groups. They have a class called "peer to peer". Until I'd gone to the peer to peer class, the only time I had been around people with mental illness was in the institution or in the hospital or in a crisis house or in a group home, and as far as I was concerned, they were living life I did not want to live. I was living a life I did not want to live. They were experiencing symptoms that were out of control and so were mine. But when I went to the peer to peer class, for the first time, I sat down in the group of people; moms, dads, you know, employed, students, all of this. And I'm going, how do you deal with this? You know, how do you wake up in the morning, every morning at 8:00 o'clock, to get to work? How do you do it? And they're going, oh, I do this. Oh, I do this. And I'm learning skills, or we call them tools, to put in my recovery toolbox. You don't use the same tool for everything like you wouldn't use a hammer to build a bike. So the more tools that you can get, the better off you are because you have a large selection of coping skills or tools to choose from, regardless of the situation. And, then, the most important aspect, we already know is rehab counselors. We need help remind those that we serve. To remind them that they are the expert at living their life. Beep. Okay. Fourth key to recovery. Creating a recovery environment. I cannot explain to you how vital this is. Oh, no. We don't have our recovery and language worksheet. [inaudible] Yes.

 

 

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[ Inaudible response ]

Okay. Sounds good. So, there's many things that a person can do to create a recovery environment. What do you think a recovery environment means?

>> Surrounding yourself with positive people?

>> Surrounding yourself around positive people. That's definitely one aspect of it. How else can someone create a recovery environment, just based on the other principals that we're already talked about? The other three principals we've already talked about. Rachel?

[ Inaudible answer ]

 

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Yeah.

[ Inaudible answer ]

Yeah, I was. Thanks. Go ahead, Lynnette.

[ Inaudible answer ]

Yeah. And exactly what you're saying. I have a different Sarah. I am an extrovert. I feel more energy the more people I'm around. My dear friend, Sarah Toss, is an introvert, and she actually finds more energy when she's able to be alone with her thoughts and really think about life in general. I will talk my face off, talk myself until I'm blue, and she is a wonderful friend because she listens! And if we both had a diagnosis, let's just say that she has my diagnosis, we would have completely different recovery environments. For me, I need to be out and with people. For her, she needs to be at home. But just like the poem said, if I'm not with people to be creating recovery environment for me, and she's at home to create a recovery environment for her, she'll be accused of being isolating and being by herself and it's not healthy, but like Lynnette mentioned, every recovery environment is unique to that individual. So, the question is: How can you help your agency, those with whom you work, create a recovery focus? Okay. Now, we'll go and we'll read down the line. Do you mind starting?

>> Sure. Value differences and strengths.

 

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>> Value differences and strengths.

>> Level of consciousness.

>> That means you're kind of more aware of those things that you're saying and how you're reacting to people. Rachel, would you mind reading one?

>> Celebrate diversity.

>> Celebrate diversity. [inaudible]

[ Inaudible answer ]

 

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Exactly. Like that poem that we read. Everyone's experienced the same things. Those are all qualities and characteristics of being human. And often times, we forget that those around us, perhaps with a diagnosis, are experiencing human life. Okay. Mike, this last one.

>> Person first recovery language.

>> Fabulous.

[ Inaudible response ]

>> So always put their needs and mention them when you're speaking their problem [inaudible].

>> Well, for example, for person first, instead of saying -- for example, I went to an activity. My friend gave me a ride, pulled into the parking lot, this really cool restored bug, light baby blue, pulled in next to us. I'm checking out this bug. I'm really impressed. And my friend who's driving me says, oh, that's my schizophrenic brother. I had no need to know his diagnosis. I have no need to know his diagnosis. I'm in a social situation and already she's tainted how I'm going to perceive him. What she didn't know was that's part of my diagnosis too and I can care less that her brother has schizophrenia. But she could have said, "Oh, yeah. That's my brother, Joe. He likes to restore bugs." Or, "Oh, yeah. That's my brother." Or "Isn't that bug cool?" You know, so that's putting the person first. Referring to them as their name instead of their diagnosis. So, let's just talk about this, and I'm just going to have Margery listen to the quote from Mitt Romney.

[ Laughs ]

 

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Marge, can you read this?

[ Laughs ]

[ Inaudible response ]

>> Look at that visualization. Now, I'd like to -- there's an article that I gave you. And this is actually an article that I wrote. It's -- at the very top of it, it says the Nauvoo Times. And what is your name again?

>> Paul.

>> Paul, do you see -- Can you read this paragraph slowly?

[ Inaudible response ]

Slowly. This one. This is just an -- from my own experience, how I experienced this picture.

>> Oh, the picture. Slowly I concluded that the unanimous opinion must have been correct. I was a crazy, psychotic schizo. I was obviously just an insanely freakish, bipolar schizophrenic that had a frequent flier card to new hospitals. Great. Talk about being counterproductive to a psychiatric recovery.

>> That is the power of language. Now, when you think about it, when someone has an illness, there's a lot of people, regardless of their illness, there's a lot of people who talk about the illness around them or behind closed doors with other people. And tell me, how does emotional abuse effect someone in, verbal abuse? Chuck, how does verbal abuse effect a child or a person?

 

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>> It has a lasting impact.

>> It has a lasting impact. For example, does the person start to believe what they're being told?

>> Absolutely.

>> Does that have an emotional toll on a person? Exactly. And that toll changes the person's perception of themselves and their perception of the world.

>> Someone is worse [inaudible].

>> Exactly. So, this is the problem. A person responds to the language used around them and we've already used, read this quote, of how I truly felt regarding the language that was used around me. What's the solution? A person responds to the language used around them, and for that reason, we need to learn how to use recovery language. Okay. So, this is going to help you understand how to become fluent in recovery language. Okay. Is it okay if you start, Paul? And, then -- it's Paul, right?

>> Yes.

>> Paul, and, then, Ed, you read one, and, then, mike, and we'll go back. Okay? So, Paul. This is -- oh, sorry. These are the questions you have to ask yourself or the thoughts you have to keep in your, the front of your mind when dealing with people with any kind of disability. In this case, we're going to be talking about people with psychiatric disabilities. Okay. Paul.

 

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>> What is the underlying reason for the behavior?

>> Ed?

[ Inaudible response ]

Thank you.

>> Respect. When referring to people you work with, use your name.

>> So, human culture. [inaudible] Address people by name. Thank you. Rachel.

[ Inaudible response ]

Taking the number away from the person, referring to the person. So, now, you all have a worksheet in front of you. Thank you very much, Chuck. And on the left hand side is a list of terms that are often found in our community or in our own work. And on the right hand side, you are going to come up with new ways to reword that. So, can we break into teams of two and go from there? I'll give you ten minutes to work on this, and, then, if you need help or if you get stuck because this is a complete different change, paradigm shift, just raise your hand, and I'll come help you.

 

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[ Small group conversations ]

Thank you, Chuck.

[ Small group conversations ]

SMI is just a [inaudible]. Good job.

[ Small group conversations ]

Got to write them down. We're going to go through them.

>> Oh, okay.

[ Inaudible response ]

Oh, let me see if I can find one for you. Oh, awesome.

[ Small group conversations ]

Now, part of this -- if I can have your attention. Part of a recovery language is shifting from using victimized language, where the person is a victim of their illness or a victim of their disability, and using survivor language or language that empowers, focuses on their strengths.

 

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[ Small group conversations ]

I don't agree with Charlie's [inaudible].

[ Laughs ]

>> I really don't want to change it back.

[ Laughs ]

>> I don't agree with how he's acting or. [inaudible] Yeah.

[ Small group conversations ]

And Sarah and Lisa, I just realized that you don't have a copy of this, and so I'm going to help you get a copy.

[ Small group conversations ]

Can Sarah and Lisa see my screen?

>> Yeah. Whatever you have on the top of your -- okay. I already e-mailed the --

>> Oh, you e-mailed it to them?

>> Yeah.

 

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>> Oh, awesome. Never mind. You're good.

[ Small group conversations ]

It happens. Don't worry. I'm letting you know how it feels like to be the student.

[ Laughs ]

[ Small group conversations ]

You guys need to write down your answers.

>> You're going to get a laugh out of it.

[ Small group conversations ]

>> Now, for that one, keep in mind -- just remember the underlying reason --

>> That's what I did.

[ Inaudible response ]

Yeah. [inaudible] to cope with pain or cope with stress.

[ Small group conversations ]

On the third one? Trouble ones. Remember, what is the underlying cause for the underlying cause for the behavior. So why does a person hurt themselves?

[ Inaudible question ]

Because she's in a lot of pain, obviously.

 

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[ Inaudible response ]

She's expressing her pain, or?

[ Small group conversations ]

Ding! Star for you.

>> Okay. I'm looking at it different. This is to explain to other people. Me, I'm looking at it like, I don't need none of this!

>> Oh.

[ Laughs ]

>> I said, imagine that you're working in a hospital where you have to communicate [inaudible].

>> Oh, yeah. Yeah.

[ Small group conversations ]

There you go.

[ Laughs ]

[ Small group conversations ]

How are we going, gentlemen? You guys aren't stuck?

>> Well, sometimes it takes double uses, still uses offensive language, like --

>> Oh, okay.

>> She's high functioning. I had said, she has addressed her mental health challenges.

>> Okay.

>> And --

>> Well --

[ Inaudible response ]

Yeah, it does. So, high functioning often means that they've learned the coping skills they need.

 

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>> But --

>> So --

>> But she copes well.

>> Yeah. She copes well. She copes well or she's using her skills or, yeah.

[ Small group conversations ]

Yeah. Don't ever think these because it's pretty easy to over think it, but sometimes they're pretty basic.

>> She harms herself.

>> But why does she harm herself? What's the underlying behavior?

 

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>> She's crazy.

>> Excuse me as I punch one of my students.

[ Laughs ]

>> No.

>> I got everybody [inaudible] with that.

>> The room goes quiet.

[ Laughs ]

>>Well, often times, the reason that people cut themselves is because they're in a lot of pain, where they feel that they're completely out of control of their own environment, and so it's the one thing that they can do to themselves that they can control.

 

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>> So she lacks control?

>> She lacks the control or she's in a lot pain.

>> Oh, okay.

>> Or she's expressing her pain.

>> She's expressing her pain [inaudible] or she expressed her --

 

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>> With how she expresses her pain?

>> This is how she expresses her pain.

[ Small group conversations ]

>> How's it going, ladies?

>> Good.

>> Oh, you guys rock, dude.

>> We're going to go back and not be able to read our answers.

 

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>> Yeah. Exactly.

[ Laughs ]

[ Small group conversations ]

>> You know what I always use the term I always use. [inaudible] tends to use it. "Freedom fighter".

>> He's a freedom fighter? He's looking for his own treatment. Yeah.

>> He's otherwise occupied.

>> Or, perhaps, the treatment plan that he has, he doesn't agree with.

>> He does not agree with your treatment.

>> Maybe he's looking for other options, but I like freedom fighter.

 

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[ Small group conversations ]

Yeah. It totally is.

>> When people actually stick up for themselves --

>> Yeah.

>> It can bring trouble home.

>> You get taken down with [inaudible]. Yeah, it does. Okay. We're going to give you about two more minutes.

 

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[ Small group conversations ]

 

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Oh, Lisa. Okay. Okay.

>> Sarah Carter's [inaudible].

>> Hey, Sarah. How's it going?

[ Small group conversations ]

Hi.

[ Laughs ]

Awesome.

[ Small group conversations ]

The other Sarah.

[ Laughs ]

Yeah. We refer to each other as "class" all the time.

 

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[ Laughs ]

And Sarah now works at the regional center, and I've applied there, so we want to continue, you know, this is like volume two of toss. The other Sarah! The other Sarah! The other Sarah! The other Sarah! We have so much fun together in class. It'd be fun to continue it. Yeah. That would be awesome. Did you get my e-mail about --

[ Small group conversations ]

 

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Awesome. Awesome.

>> Sarah. Sarah garner. Sarah, just read everything.

[ Small group conversations ]

Okay. Okay. How -- are any of you finished? Almost? Okay. Okay. Just give you 30 more seconds.

[ Small group conversations ]

>> Hey, Sarah?

>> Yeah.

>> Sarah Garner says every person's diagnosis is not even on their plan, so.

>> Oh, that's awesome, Sarah. Yeah. I do want to work there. That'd be great.

[ Small group conversations ]

 

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Yes.

 

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[ Small group conversations ]

I like having things organized or -- yeah. I like -- I have things -- I like things a particular way.

>> All my way.

>> My way or the highway.

[ Laughs ]

Okay. Let's go ahead and go through this worksheet. And as you come up with ideas because there isn't a wrong answer to this, but there might be a better one. So, we're going to help each other with this. Okay? So, the first question, or the first thing, non-recovery language, I work with SMIs. Go ahead, Paul.

>> We put, I work with people.

>> I work with people! Perfect. Any other ideas? Mike?

>> [inaudible] I work with people who have mental ability challenges.

>> Okay. That still has negative connotation. So, I work with people who have a diagnosis, or I work with people. Perfect. Okay. Charlie Sheen is insane. Goes without saying, but --

 

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>> Charlie Sheen needs to see the recovery model.

>> There you go!

>> There you go!

>> Nice! Charlie Sheen needs to use the recover model! Awesome. Okay. Anyone else?

>> How about Charlie's different?

>> Charlie Sheen is different.

>> Yeah.

>>That's very true. Sonight, did you come up with one?

[ Inaudible response ]

Charlie Sheen what? [inaudible] That's actually kind of more medical model. Whoops. But you want to actually describe the person. So, Charlie Sheen is eccentric? I don't agree with Charlie Sheen's behavior. Often times when we're calling someone insane or crazy, it's because we don't agree with them.

>> Charlie Sheen operates outside sanity.

>> While that is creative, it's not exactly recovery language. Okay. She's high functioning.

>> Highly talented.

>> Highly talented? Mike?

>> Independent.

>> Independent.

[ Inaudible answer ]

Oh, Francis.

[ Laughs ]

 

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Okay. Lynnette.

[ Inaudible answer ]

 

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Oh, that's good. Okay. Often times when people are labeled high functioning, it's because they're able to cope with their circumstances. And, so, perhaps you can say she has good coping skills, or she utilizes her coping skills. That way you honestly know why the person is able to do what they're doing. Go ahead, Mike.

>> The column on the left, was this developed or just come from the culture? Maybe just shortcuts that people use and are now starting to see that they're not carrying.

>> Yeah. It is from the culture. I took a lot of these directly from phrases I have heard used about myself or others that I know. Although, I do not know Charlie Sheen. Okay. Next! Rachel, I liked your answer for this. She's a cutter. She's expressing her pain. Remember, it's always -- as you are working with people, you need to remember the reason behind things. Remember the underlying cause. Anyone else?

 

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[ Inaudible answer ]

That's good. It depends on, you know, every person's different.

>> I think when you're in any sort of human service political setting, you need to be able to communicate these ideas.

>> Yeah.

>> You have to make sure you're not obtuse, at the same time.

>> That's very true.

>> From one clinician to another, the fact that somebody is doing cutting behavior needs to be communicated.

>> Yeah. And I think that when you say she is expressing her pain by cutting, or instead of referring to her as a cutter --

>> Yeah.

>> That takes, that moves the focus to her as a human. Yes, she's in pain. Yes, she is cutting. But you're right, Marge, because you, as a clinician, you need to record these things so that she can get better treatment. Okay. Next! Mike! He's a frequent flier. Are you familiar where that term?

>> In this class, yes.

>> Yeah!

>> And Marge is [inaudible].

 

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>> Francis.

>> He's been here often.

>> He's been here often. And interestingly enough, my -- in my own experience, I would go to the hospital after starting to believe the voices that I needed how and why to kill myself 24/7. I'd start believing them, and so I would check myself in. My doctor looked at it as I was seeking attention. I looked at it as I was being proactive in my treatment. So, really, you have to understand the motive behind -- you know, don't assume the person wants attention. I mean, if I wanted attention, I'd graduate from school and do something worthy of helping others, publish my book, climb Mount Everest, you know? All the things that I'd want positive attention for. Who wants to be getting attention for going to a hospital? I do not have Munchausen's. Okay. My schizophrenic cousin.

 

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>> My cousin, period!

>> Yeah.

>> Period!

>> Yeah.

>> Perfect, Ed. Thanks. Okay. I've got a case load of 250. Sonight?

>> I work with many people.

>> I work with many people? Or I work with 250 people. I serve 250 people. Ed?

>> Clients.

>> I work with 250 clients. Clients though, still has a connotation of being less than. You need to -- you still need to remember that. He's psychotic. This is kind of a difficult one, isn't it? Because you still need to convey.

>> What if you said, like, he's not sure what's real?

>> He's not sure what's real?

>> What's real.

>> Well, that's true. But I can honestly tell you as someone whose experienced psychosis, it's very real to me. So, you might want to say, experiencing an alternate reality, or we don't share the same reality. She's grandiose.

 

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>> I didn't --

>> She's confident.

>> She's confident? I think this term is way overused. "Grandiose" should be used if the person honestly believes they are god or if they honest believe they're the President of the United States or, and they're obviously not. Then you say they're experiencing an alternate reality, not grandiose. Okay. He's noncompliant. Mike?

>> He does not agree with the course treatment options.

>> Woo. Ding! Ding! Ding! Gold star. What did you put, Dalveen?

>> We put he's choosing a different treatment plan.

>> He's choosing a different treatment plan? That was right along with motivational interviewing as a counselor who implements motivational interviewing. Part of the process is rolling with resistance and finding out the underlying, why are they resisted? What do we need to do to help this person move forward to change? You've got crazy skills, Paul!

>> Are we on "she's grandiose"?

 

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>> No. We're on "you got crazy skills".

>> Oh. I didn't get that one, but keeping it simple, she's talented.

>> She's talented. She's got amazing skills. She's dripping with skills. She has so many skills that I just wish I could be like her. I'm not talking about myself. I swear.

>> She's multitalented.

[ Laughs ]

>> Multitalented. So often we get caught using these euphemisms that become meaningless because everyone else is using them, and what we really need to be saying is what we're really thinking. Because I can honestly say when people say they've got crazy skills or when someone says they've got crazy whatever, it immediately takes me back to when I was being called crazy. And I think it's the same for all of the other slurs that we've already gotten rid of as a society. If we're decent human beings, I honestly feel "crazy" is a slur. Everyone tells me, oh, you're never going to be able to weed it out of society! But I can tell you that every time someone uses that term, if I watch it on TV, if I hear it on the radio, if someone at the next table is saying "crazy talented", "crazy good food!" It immediately puts me back into one of the situations that I was in when people were calling me crazy. Okay. I've got an insane amount of work! Same thing from my perspective. It immediately puts me back into the first or eight millionth time I was called insane. How would you change that?

 

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>> Overwhelming.

>> Overwhelming?

>> Tremendous?

>> Tremendous! Exactly! It means -- it's just a process of using our words. Her mom is a loopy. Chuck.

>> Her mom is --

>> [inaudible] You turn red well.

[ Laughs ]

>> Her mom is --

>> Unique?

>> Yeah. Unique. Yeah.

>> Okay. We gave you that one. How about the next one? Psycho?

[ Inaudible answer ]

Perfect! Cross it off! Cross it off! Eliminate it! You know, but, again, that is one of the terms that people have used to describe me, and when I hear someone describing someone else as psycho and I'm looking at the person and it's just because, you know, they're crossing the street in the middle of the road instead of using the sidewalk, immediately, I'm still being -- you know, that person is not psycho. That person is a person, and, yes, they're doing something differently than the way you would, but that doesn't make them any less of a human. Okay! Rachel! They're low functioning.

 

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[ Inaudible answer ]

You can use that.

[ Inaudible answer ]

>> They're still learning coping skills. Perfect. [inaudible] Yeah.

>> I think it's a complicated one. I hate using high/low functioning. I mean, it's awful, but in order to communicate the idea, I've used, he has a lot of support means or needs more support.

>> He needs more support from other people. That's -- because your right. It does need to be conveyed.

>> Yeah.

>> Okay. He's just being paranoid. Going back to that poem.

>> Being cautious.

>> Being cautious?

[ Inaudible answer ]

 

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Good quote?

>> Yeah. It's, "I'm not paranoid. I'm extremely well formed about all of the things that can go catastrophically wrong."

>> Oh.

[ Laughs ]

I like that. I like that.

[ Laughs ]

Okay. It's complete religiosity. Are you familiar with that term? When someone goes, for example, sometimes people, when they're truly experiencing psychosis, they think they are a deity, or I have met a person who was really into reading the bible and finding all of the patterns within the bible, finding patterns that weren't there. But I have also been deemed religiosity, having problems with religiosity, and it was actually because the person didn't understand my faith. Yes, I do say a prayer when I wake up and when go to bed. Yes, I'll pray over my food, especially when I cook it. I need all the help I can get.

 

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[ Laughs ]

But I also read my scriptures daily, and the majority of the people who adhere to my cultural principals do the exact same. So, I actually was up at Alpines, and they were having a meeting with me to give me my new diagnosis of OCD because I had problems with religiosity. And I was sitting there and I turned to my friend who was Jewish and I said, do Jewish people, you know, do they do all of these things? And if they had nothing to read and they're bored and they have a Torah sitting next to them, do you think they'll pick it up? And, oh, she's, you know, going, oh, yeah, yeah, yeah. And I said, okay. Because I was comparing to Orthodox Judaism and I said, okay, so, I do all of these things too, so, please, consider me an orthodox Mormon. And she looked and she finally, she put her hand on the table, she's not OCD! And I was so grateful because, really, I was just living my religion, and as counselors, who are we to decide how a person expresses their religion or their faith? Okay. So, we've got through that, and we're just finishing up here. Sorry to take you over. The fifth key to recovery, and this is most vital, is finding meaning and purpose in life. For a large of a majority of people that means tapping into some kind of spirituality, be it yoga, Buddhism. Whatever kind of Higher power that people identify with. Whatever gives them meaning and purpose. Help, help your people find meaning and purpose. Perhaps it's through community service. They feel meaning and purpose by sharing their talents with other people. Whatever it is, help them find meaning and purpose. So, now -- whoops. Now that you know who I am, now that you understand the recovery model, I've become more than just a number, more than just a diagnosis. And that's the end of my presentation.

 

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[ Applause ]

Thank you, everyone, for coming.

>> When's your next one?

>> When's my next one? That's great!

>> You're all here!

>> I'm going to call you Francis from now on.

[ Laughs ]

I actually lecture very frequently. I've lectured in five, or I should say four of the marriage and family therapy programs in the area, and I'll be lecturing at UCSB for their psychiatric fellows post-doctoral fellows on Tuesday. So, if you are aware of an agency or of a university professor in a helping field like counseling, social work, nursing, psychiatry, rehabilitation counseling. I travel. I love sharing this. This is actually a very condensed version of this [inaudible]. Yeah. But, anyway. Thank you. Thank you very much, Chuck.

>> Sure. Stop the recording.

 

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