September 16, 2009

In a few weeks, I’ll begin working (and playing) with a new International Class—grass roots community activists and scholars who will gather at the East Side Institute for their first residency. Coming from different places and professions, they share a desire to change the world—and an eagerness to take advantage of the unique opportunity that the International Class offers them to create a global support network, to engage the philosophical, political and psychological issues of their practice, and to study and train as developmentalists with the creators of social therapeutic methodology.

At the same time as this new grouping is forming (it’s the sixth year of the program), recent grads continue to work together and support each other. Some of them composed letters/emails sharing their experiences of the Class and its impact on their work and lives. Before sending them to colleagues, they posted them to each other. For the past week or so they’ve been discussing how people in therapy are referred to in their different cultures, and engaging in a fascinating deconstruction of various terms. I asked their permission to post some of their conversation here (they said yes!).

The catalyst was part of the letter Lisa, alum from Brooklyn, NY, wrote:

During this time I also came into social therapy as a patient. I had been in therapy before. Some of it was helpful. But for the most part it was focused on understanding myself—why I was the way I was, what was wrong with me, how to fix my problems. In social therapy the focus was on the group—on what and how I could create with other people in the process of building the group. Social therapy didn’t fix me or take away my craziness, but it helped me build relationships and create my life without being overdetermined by my craziness and my problems.

When they read Lisa’s letter (which they liked overall), some alum questioned the word “patient.”

Peter, in Uganda, commented:

Hi everyone,

Great to read from everyone. I really have enjoyed your writings, thank you.

Lisa, thank you for that piece, I think it’s great. However, I wanted to comment on the word “Patient” as used in the 2nd paragraph. ”… having been a patient for a number of years…..”

Since you have not sent it to the people you don’t know yet, I thought we could change that to another word, though I really don’t know the best word to use, probably “Client”, but I am not sure. Maybe I can invite the group/Lois to comment on it. Otherwise, it’s great.

Lisa responded:

I am open to changing the word “patient,” but I am curious to know more about why you think it would be a good idea and also what everyone else thinks.

One of the things that I think is revolutionary about social therapy is the concept that the “patient” is not a vulnerable, passive, stigmatized person but rather a powerful, active agent in changing his or her life and the world. Or to put it another way, in creating his/her group/therapy. That’s why I am inclined to use/challenge that word. But I could also say “client” or “member of a social therapy group.” Thoughts?

The conversation continued.

From Esben, in Denmark:

I had the same response as you, Lisa – I like the word patient because it’s somewhat of a joke, in the sense that it does not refer to the conventional meaning of patient as passive vulnerable recipient/victim – however, I don’t know if you should make the point clearer, i.e. that in social therapy the patient is “a powerful, active agent in changing his or her life and the world. Or to put it another way, in creating his/her group/therapy.”. I do think using the term patient in this way does help to deconstruct and destigmatize the ‘role’ of patient.

I also just wanted to note that I feel so privileged every time I discover an email from my international friends and colleagues – we’re quite a task force ;o)

Hugs,

From Simon, in Canada:

Hi All,

Regarding the use of the word patient: At first, I thought that the use of the word was just fine; however, when the word was singled out for discussion, I started to think how I dislike the word client, but it also serves a function, just like the word patient, right? Nevertheless, technically, I now wonder if Lisa was ever a patient or was she more like a client? I mean to say that this all seems to be an interesting language game or a real good “joke” (as Esben says). I am not sure Lisa was a patient when I think about - I mean, will the readers get what Lisa is doing linguistically? Well, I would like to think some will. I come to “understand” a patient to be one who has simply received medical treatment; so, the question for me is, has Lisa ”undergone” and is “undergoing” or ”involved in” a psycho-therapy treatment, which would be considered to be providing medical treatment? In North America and many other places in the world, a client is a person taking advice from an attorney, accountant, or another professional person – and in this case, what arises for me is the idea of professionalism and what is a professional? A therapist seem to me to be a professional – so is Lisa a client – does Lisa take advice and does the therapist really give advice? or does the relationship consist of something more allusive . . . is it a unquantifiable exchange or more to the point, is it not a building of community, which is so much more complicated than the capitalistic client-customer-patient model can address? In other words, the relationship between the therapist and Lisa – found within the context of social therapy - is unclear to me actually – the line of client and/or patient seems to me to be blurred, not just because money exchanges hands, which makes Lisa a customer . . . a client . . . a buyer of mental goods (however you want to describe it); but more importantly, if the patient, as a concept “is to be understood as vulnerable, passive, stigmatized person, rather than a powerful, active agent in changing his or her life”. . . I agree with those that have suggested that as long as the point is made clear – as I believe Lisa has done – that Lisa’s idea of being a patient is her “becoming a powerful, active agent in creating her group/therapy,” which is in turn, allows her to create developmental possibilities – WELL, so be it – in this case, if it is good for her, it is good for me.

It was Fun playing with you all Thank you for the opportunity – what a wonderful debate :-)

From Ishita, in India:

Dear Friends

This reminds me of the debate going on worldwide to change the term Schizophrenia. But changing the name does not always change its impact. We need to change people’s outlook, transform the perception of the community towards people suffering from mental illness. Any person can be a patient any time (either suffering from physical or mental illness), so to me patient is a state of human being at particular time and place and not a description of the human being at all.

But we in our center use the term beneficiaries.

Love to all

From Prativa, in India:

I feel that in general the term “Patient” itself refers to a sick person either physical or mental. As we have seen in social therapy sessions, each member of the group is creating an environment for emotional development where they are trying to overcome stigma related to the terms “patient” and “illness.” Lisa, you are also too bold in your expression that I could not match the term patient with you. But I appreciate your revolutionary thought and attempt in using the term “patient.”

From Peter, in Uganda:

Wow, this turns into an interesting conversation, thanks for everyone’s contribution and I feel they are all great.

I commented about the word “Patient” in the context that we (the group) are trying to invite people (both that we know and we don’t know) to learn about Social Therapy and the International Class. And it’s the reason I said to Lisa that it was good she had not sent it out to the people she doesn’t know.

This was because, echoing Prativa’s word that the term “Patient” refers to a sick person, it’s quite easy for one to exonerate/excuse themselves that they are not patients (sick) to join social therapy. But believe me or not, so many people out there, (we are all) either mentally, physically or emotionally “sick”, but they (we) don’t want to believe or accept the fact that they (we) are sick.

Quoting Ishita’s words too (by the way, thank you Ishita for your wonderful contributions), that “we need to change people’s outlook, transform the perception of the community towards people suffering from mental illness,” is another example to show that people don’t want to associate themselves to “illness.” ?I may agree with Lisa when she says, “A patient” is not a vulnerable, passive, stigmatized person but rather a powerful, active agent in changing his or her life and the world, but for any person to understand that, they need to first join and learn/understand what social therapy is all about and to whom it is intended.

Maybe if we may ask Ishita why do you (at your center) use the term “Beneficiaries” to mean “Patients”? probably it will also help us to understand more why we may or may not use the word “Patient.”

From Ishita, in India:

I am enjoying our group discussion.

These are all mainly game of language. But it has some inner meaning too. I think when you are going to a doctor, teacher, lawyer, you expect to be benefited from these professionals. So we use the term beneficiaries who are coming to our center for that particular time for getting some benefit in their life which may be due to some reason they cannot do on their own. Peter, I agree with you as people often refuse to accept themselves as patient when suffering from mental illness, but in the case of chronic schizophrenia or other problems we have seen people prefer to remain in that state as it appears to them a comfortable situation where they need not be active, face challenges of life and think, “I cannot do that because I am a patient.” They do not want to change their performance and they play the same old role day in and day out.