“Ageless Passion” and Personal Reinvention: An Inner and Outer Dialogue

Here is a two-part mailing inextricably linked by a personal/relationship crisis challenging me to reinvent myself (once again).  First is another of my “Psychohumor Pops:  Poetry with Pith and Punch.”

And the second offering is both a highly personal response and then a somewhat academic one regarding the “Medical Model of treatment for Veterans grappling with Severe Mental Illness.  The first two “Self-Assessment Narrative Questions” are part of a one-year VA Psychosocial Rehabilitation Fellowship Application.  The VA is looking to attract individuals interested in pioneering new models and then have the purpose, passion, and presentational presence to spread these models throughout the VA System.  Attached is the entire Narrative.  So despite the age gap between myself and the typical applicant…here’s my best shot.

When a friend heard I was applying for this VA Fellowship, she noted that "passion is ageless."  She knows my Boomer/Medicare status.  I couldn't resist my brain's unfolding conversation.  Whatch'a think?

A Question of "Ageless Passion":

An Inner Dialogue

You're nearly sixty-seven
Way beyond ol "sixty-four"
Just who are you kiddin...
Time for sittin and a rockin
Sunshine State hibernatin
"Ageless passion," pshaw.

Are you comin or a goin?

That depends; where's the door?

Is this a mighty vision
Or more hallucination?

Ya know, I'm not sure...

But I'm itchin to explore!

© Mark Gorkin  2015
Shrink Rap ™ Productions

~~~~~~~~~~~~~~~~~~~~~~~~

 

INTERPROFESSIONAL FELLOWSHIP PROGRAM IN

PSYCHOSOCIAL REHABILITATION and RECOVERY-ORIENTED SERVICES

 

For Care of Veterans

Who Experience Serious Mental Illness

 

(SOCIAL WORK ANNOUNCEMENT)

 

The VA Palo Alto Health Care System is pleased to announce openings for the 2014 – 2015 academic year of its Interprofessional Fellowship Program in Psychosocial Rehabilitation and Recovery-oriented Services for veterans with serious mental illness. The Fellowship Program is a state-of-the-art, clinical training program that focuses on the theory and practice of psychosocial rehabilitation and recovery.

Individualized, mentored clinical and research training is combined with a curriculum that emphasizes a comprehensive psychosocial rehabilitation approach to service delivery, education, and implementing change in a mental health care setting. Fellows will work with veterans with serious mental illness, including schizophrenia, schizoaffective disorder, bipolar disorder, major depression, or other psychoses and receive training in delivering a range of evidence-based practices. Veterans may also have co-morbid diagnoses, such as PTSD, substance use disorders, depression, and anxiety. The purpose of the Interprofessional Fellowship Program is to develop future mental health leaders with vision, knowledge, and commitment to transform mental health care systems in the 21st century by emphasizing functional capability, rehabilitation, and recovery.

~~~~~~~~~~~~~~~~~~~~~~~~

 

Self-Assessment Narrative

 

1.         What limitations do you see of the medical model of treatment for individuals who experience severe mental illness?

 

The medical model has evolved some since my father’s alleged enraged “manic depressive” breakdown sixty + years ago, six weeks in a mental hospital, and fifteen years of shock therapy treatment.  (Based on an immigrant family tree littered with psychiatric labels and the pressure of being a twenty-something breadwinner with a 1.5. year old child, a breakdown and need for “time out” does not seem so aberrant.)  Parenthetically, I suspect his diagnosis may have been “agitated depression” with hypomanic tendencies and some self–medication with alcohol and tobacco, as, 1) he never had a Lithium trial, 2) and, after fifteen years, once he stopped the shock therapy, then 3) went into individual psychotherapy for several months followed by twelve years of group therapy; 4) he never had another shock treatment in the ensuing half century, and even quit smoking while moderating his alcohol intake.  And the only time he took psychotropic medicine, some anti-anxiety meds I believe, was during a brief audit by the IRS.

 

He functioned well enough as a salesman to retire at sixty, walking to his new daily therapy – the tennis court!  However, at mid-life, it took existential desperation and a heroic act to stop the shock-a-thon despite my mother’s and his doctor’s misgivings.  (Okay, there was the encouragement of an outside resource, i.e., a woman with whom he had a brief affair, before deciding to work things out at home.  According to my dad, the woman said, You’re nuts; you don’t need shock therapy, get into psychotherapy!   From the time I first heard about dad’s medical diagnosis and regimen, it took six years, and my own individual and group therapy, to finally have the courage to ask him about his shock therapy trials and hard-earned liberation. His breakdown and shock treatments had been a nearly twenty year family secret.)

 

While a vintage vignette, some of the current “limitations” of the medical model come into view:

a. while any therapeutic method – whether medical or psychosocial – may misdiagnose, the medical model, often relies on treatment procedures administered by “the expert” to a passive patient, hardly a partner in the healing process, mostly dependent on the authority, knowledge, and skill of said expert.  The good patient is “compliant” and follows “medical procedure,”

b. as the medical model often emphasizes symptom relief and the ability to “function” adequately in one’s environment, (my father was able to be a good “breadwinner,” though a somewhat depressed and distant father around the home during the regimen era), it may not examine holistically a person-patient’s life; the method just might overlook the many work-family-life roles a person plays beyond “patient,”

c. the medical model may not envision the patient as active treatment partner; nor may it have a genuinely interdisciplinary partnership team working with the “client” or “patient” (depending on the local/professional vernacular).  Hence, it may be more difficult for a patient (or even a professional team member) to question, let alone challenge, the established therapeutic protocol,

d. the medical model is not predisposed to fully appreciate the perspective and power of “community resources,” such as the “other woman” in this family drama or use resources like www.uspra.org  www.psychrehab.com, or even other 12-step recovery groups,

e. while often  “keeping members informed,” the medical model may not actively engage with and integrate family members and significant others in developing a psycho-social, in-patient, and/or discharge career & community rehabilitation plan, beyond bringing the patient home (if so fortunate to have a home base).

 

2.         How do you currently conceptualize a psychosocial rehabilitation model and recovery oriented services for individuals who experience severe mental illness?

 

Let’s use the above vignette as a “what not to do” template for generating “psychosocial rehabilitation model and recovery oriented services for individuals who experience severe mental illness.”  The PSR model:

 

1. establishes a diagnosis and intervention plan based on an integrative bio-psycho-social-cultural assessment; a plan that empowers an open, “helmet’s off,” interdisciplinary team climate and practice,

2. strives to help each person-patient reach their full potential as an active healing/rehab process partner,

3. regularly evaluates it’s diagnoses and intervention procedures based on the individual’s: a) daily functioning, b) capacity to consciously if not empathically connect in a variety of relations and roles;

c) overall competence and confidence; d) a capacity for vital engagement as well as “R & R”; e) it’s a model that wants to explore realistically the person’s capacity to thrive not just survive and be mostly coping with symptoms (especially to another’s satisfaction),

4. provides a purposeful mix of individual and group, clinical and educational, in-house, team-, family-, and career & community-building practices, services, and relationships,

5. engages with the strengths, resources, anxieties, and vulnerabilities of the patient and family system; actively seeks to involve friends and/or non-traditional significant others in a rehab process and plan,

6. explores using interactive-educational-camaraderie-building group “playshop” exercises and the power of healing and harmonizing humor as part of a PSR process; as I once penned:  People are less defensive and more open to a serious message gift-wrapped with humor, and

7. integrates the “Stress Doc’s ™ Formula for Natural SPEED to Strengthen Stress Resiliency and Brain Agility”:  Sleep-Priorities/Passion-Empathy-Exercise-Diet!

 

5.         How do you see yourself implementing PSR/recovery-oriented services after completing this Fellowship?

 

First, I want to deepen my clinical and psychosocial understanding and engagement with SMI patients – their pain and problems, passions and purposes.  Then I want to combine this “head-heart-and-hands on” knowledge with my powerful military (and non-military) interactive group workshop and  training/leadership experience.  (Are my “interactive educational-playshop methods” viable with this group?)  Such clarification and unification becomes the basis for my “Education Dissemination Project.”

 

The synergy of clinical assessment with group support and skill-building activity along with advocacy will enable me to deliver group-psychosocial rehabilitation education-training to both:  a) patients in the VA Hospital System (soldiers know the critical value of teamwork), and b) to all levels and locations of professionals as well as to family members who work with or support these patients.  A longstanding goal is to share information-ideas-and purposeful activities that I have developed and about which I am passionate, i.e., that will make a difference in people’s lives.  Being on stage allows me to share my fullest self without, hopefully, being full of myself.  Usually, my presence has an inspiring impact on others.  I also would be excited at the prospect of “developing continuing education or research conferences for health professionals, curricula for health professions training programs, patient education materials, or clinical demonstration projects.”  With my love of writing (see my Google blog: http://www.blogger.com/home), I would enthusiastically “develop didactic projects and disseminating educational materials through a variety of efforts (e.g., planning regional invitational meetings; though developing a training website I would need to partner with one more tech savvy), in order to educate health professionals and advance psychosocial rehabilitation training and collaboration.”

 

I believe a solid, synergistic foundation would enable me launch and spread a “PSR/Stress Resilience-Humor-Team Building” Model and Message throughout the VA.  (Akin to my approach with all grades of soldiers, especially at Ft. Hood.).  And I choose the word “synergistic” purposefully – not only does my “assessment-activity-advocacy” paradigm achieve a “whole that’s greater than the sum of its parts” but, the real magic, is that these parts/people often transform into productive partners.  (See attached testimonials.)

 

Finally, I believe humor therapy is the icing on my PSR cake.  As the psychosocial pioneer Helen Keller observed:
 

The world is so full of care and sorrow, it is a gracious debt we owe one another to discover the bright crystals of delight hidden in somber circumstances and irksome tasks.

 

All I can say is Amen and Women to that!

~~~~~~~~~~~~~~~~~~~~~~~~

See attached for all the application responses