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?
Or more hallucination?
Ya know, I'm not sure...
But I'm itchin to
explore!
© Mark Gorkin 2015
Shrink Rap ™ Productions
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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
