Respecting the humanity of a person with serious mental illness

Hmmm, your dream?…unfortunately, the predominant question in the mental recovery experience is, “What is your diagnosis?” Clinicians generally focus on symptom reduction and management. That’s understandable because symptoms of serious mental illnesses can sometimes be frightening and even life threatening.

However, relegating a person with ‘SMI’ to being an object with symptoms and without the capacity to dream can also be deadly. To be human is to be able to dream, to create a vision of one’s future and to hope and plan for success.

I remember an anguished call from an Ohio mother. She and her son had visited his psychiatrist who stated that his schizophrenia had destroyed his ability to define and achieve his dreams. Her son grew silent. As they left the psychiatrist’s office her son kept walking across the street to the tracks where an oncoming train took his life.

I recall also conversations with Dan Fisher. On his seventh hospitalization for schizophrenia, his psychiatrist asked him, “What is your dream?” His response? Dan said, “I want to be a psychiatrist!” His psychiatrist did not step on his dream and Yes… Dan became a psychiatrist and also has a Ph.D. in biochemistry. You can read about him here.

The journey that is mapped out by answers to the questions about diagnosis and dream can be daunting. Anxious thoughts can emerge. “Dare I dream of achieving and sustaining a meaningful life if I have a serious mental illness?” “Will my family believe in me?” “Will my clinical team support me?”

Too frequently the ‘Dream Question’ is never asked. Or clinicians may advise that the diagnosis and symptoms must first be managed before asking the question. One result of this absence or delay is increased chronicity, indifference and resignation… being treated as no longer being fully human, the person with serious mental illness may simply give up.

Bill Anthony, father of the recovery movement, was also a friend, whose heart was joined with research demonstrating that with the right support and coaching people with active psychosis could hold a job and develop a meaningful role in society.

It is wise simultaneously to help someone with mental illness to work on diminishing the impact of their diagnosis while increasing their hope for achieving their dream. I was once asked, “Virgil, might this result in false hope?” My response? “Hopelessness is far worse.” You never step on someone’s dream. You show them that you believe in them and help to support and adjust their goals as they define and seek to achieve them.

Too frequently, when I might ask (as I have done hundreds of times) “What is your dream?”, the answer I would get is “I don’t know. No one has asked me that in years.” I have found that offering a dose of belief in such a person helps them to enter a discovery phase… they try on options and they start imagining a better life for themselves.

In my last executive director role at CooperRiis in NC, the treatment planning process was structured to address both the dream and the diagnosis questions. Each resident created a ‘Dream Statement’ with accompanying goals. Within our therapeutic community they could also ‘try on options’ during their participation in CooperRiis’ work and social programming. Our research over ten years showed that this approach did indeed keep realistic hope alive.

I experience great joy knowing and am still ‘walking with’ individuals with serious mental illness who are now leading more fulfilling and functional lives. I have also felt great pain knowing some who had their dreams (and their lives) diminished rather than emboldened by clinicians, family and friends.

I conclude with a memory of a night sitting with Oliver Sacks around a campfire outside of the lodges at CooperRiis. He knew both CooperRiis and Gould Farm well. As he thought of his brother who had died with schizophrenia, he said, “These are places of hope; I wish my brother could have had an experience here.”

Help to keep hope alive! if you know someone with serious mental illness, ask them, “What is you dream?” … and then listen supportively. If there is just a spark, fan it into a flame. The goal is not just for them to awaken into a day without symptoms; the goal is to help them awaken into a day where they (and you) can believe that they can discover meaning, while building a sense of purpose and healthy relationships.