When conducting Visual Connection Mapping sometimes I may or may not consider what is justice and what is not justice.
Three components of justice that I may / or may not consider when applying Visual Connection Mapping are from the principles of the Code of Hammurabi from 1772 BC, namely
Scotomata
Ein Zustand, der so ausweglos ist, ist verschuldend.
(A situation that is inextricable is guilt-producing).
Walter Benjamin
During my face to face working at the Our Place Society drop in center, where Victoria City’s most vulnerable citizens go for food and shelter – I conducted Visual Connection Mapping (VCM) each Wednesday morning pro bono from 0900 to 11 am. After many sessions there with clients, I would often do investigative studies into my findings at the drop in center to make my understanding of the psychiatric symptoms displayed by clients bring me more awareness. My intention was if I educated myself on components which I was exposed to by the clients I would be better equipped and better able to help both them and me decipher the psychiatric symptoms at the next drop in center. This way I could provide more continuity of care and my aim was to provide a higher quality of continued service to the client.
The process of my investigation often led me to use peer academic database systems, such as the one at the University of Victoria (UVic)’s McPherson Library. My keyword searches were often based on the clients’ conversations that I had with him. (The majority of the clients were male, that is why I am using the word ‘him’ versus ‘her’). So my first component was to investigate [A] the conversation content.
Then what I often did was [B] investigate the psychiatric symptoms. For example, if I believed the vulnerable individual to have suffered from psychosis, treatment resistant psychosis or symptoms of serious mental illness, I would try to figure out what psychiatric symptom could best be used to classify the strain – and often I would delve into that singular symptom to gain more clarity into the subject. I often referenced books in the Psychology section of the McPherson Library, UVic.
Notes:
[A] Conversation content components that were investigated
[B] Psychiatric symptoms
Image of Ambivalence
Part 1: Introduction – What is Visual Connection Mapping?
Since April 2014 I have been going to the University of Victoria’s MacPherson Library to find answers as to how to best solve homelessness in Victoria City. My journey took me through many different avenues, from Philosophy to Medical books and from the Jewish Holocaust to Modern Germany today and then right back to Victoria City, at the Our Place Society where individuals whom are marginalized seemed to find themselves. What I found in my search is that in the past in the times of around 1890 there was a growing dystopia towards the marginalized. This seemed to be escalating and it hit its height in World War II. After World War II it was written that good triumphed over evil but on deeper analysis of the facts, I wonder if that was really the case at all, as political systems seemed to be ambivalent. Ambivalence is a symptom of schizophrenia according to the 4 A’s of Bleuer. Affect, Autism, Associations and Ambivalence.
What I realized was the effects of the ambivalent factor trickle down into almost all Western civilized countries such as West Europe and the Americas. This symptom of schizophrenia has somehow ended up in Victoria City and I believe it is what is pervasive amoungst the individuals who visit the Our Place Society drop-in center on Wednesday mornings when Visual Connection Mapping is conducted. The symptom of ambivalence is a medical term used in the context of being part of a Medical Model, serious mental illness sickness, and it is the most serious of illnesses, namely schizophrenia. Could it be possible that the whole of Western Society has contracted the dominant symptom of schizophrenia, namely ambivalence? What would the outcome of Western civilization be if that was the case? Would it mean a re-evaluation of all citizens lives? Would it mean that every citizen would need to be treated for the schizophrenic symptom of ambivalence? Or would it mean business-as-usual and denying that this observation ever came to light and hence burying this fact for ever and ever?
The next question that I was encountered with was who are the saints and who are the devils? Are the homeless people the saints because they are really victims and really part of Victoria’s Mental Health Medical System, and patients of the Medical Model. Or are the doctors and counselors the devils as they practiced an unauthentic one-way reciprocated communication asserting their authoritarian power over the patients – within the context of the Involuntary Treatment clause regarding schizophrenia in the Mental Health Act.
As a sophisticated society, how far have we actually come? Are we not stuck in the 1940’s mode of conduct? Where fear tactics and assertions of perceived justice over-ride the human rights of marginalized individuals. The ambivalent factor is something that did not just appear in the 1890’s onwards but has been around since the beginning of time. Within the Old Testament within the text of Jeremiah, there is a constant cry of mercy and a feeling of pain caused by the punishment Jeremiah is experiencing. Is not God good? Should not God help Jeremiah instead of punish? What kind of a God is Jeremiah’s God anyway? Within the context of being at Our Place Society and seeing the disparities with my own eyes I have often felt that God was punishing these individuals and condemning. What I was witnessing was so far from any kind of logic that I could not get my head around it. I started reading the Bible in order to understand. I came to two conclusions, one the God was man and second that the Old Testament was joint to the New Testament and could not be interpreted as separate and that from confusion in the Old Testament came light and clarity in the New Testament. I then remembered my
Roman Catholic ancestry and my Roman Catholic University education and then many components seemed to line up for me again. I started to view homelessness in the stage of the Old Testament where psychological development needed to further evolve itself in order to break free from the torment and psychological distress. In order to try to help individuals in this predicament I reached for a communication device that could capture and at the same time transcend psychological distress and that was the birth of the Visual Connection Mapping technique.
Visual Connection Mapping was all about the individual, their own unique existence and it was about mapping their existence into a diagram so that they could physically see the concrete design of their verbal creation. Visual Connection Mapping is so much more than lines on a paper, it is the soul of the other person, their words mapped out like geographical lines defining a new country. Visual Connection Mapping goes very deep into the abyss of a human being and draws out something that has not been brought to light before. It is a human phenomenon and it is not a calculated perceived idea, it is the opposite of that. It is the free-flow of line frequencies and dimensions of feelings and experiences that often get missed in a regular conversation. It is the capturing and the noting down of intricate psychological details that go beyond the 20/20 vision of a regular eye-sighted individual. Visual Connection Mapping taps into the unconscious nature of an individual in a very non-coercive way. It does not provoke, investigate and analyze instead its nature is all-encompassing compassion and empathy. Visual Connection Mapping is psychosis friendly. It is pro-psychotic and it is intended to work as a paradox. The more acceptance of symptoms one is, the more the symptomologies start to fade into the background and the more and more the unique personality comes to light. The Visual Connection Mapping is not some kind of quick fix to end all human pain and suffering instead it is an element to help cope with pain and suffering temporarily. It is a human composition. Often it is two human beings trying to help each other versus one individual being the helper and the other the client. The intention of Visual Connection Mapping is to dissolve stigma and replace it with understanding which is intended to lead to self-empowerment and the finding of oneself through understanding ones true nature and through ones own Existentialism.
Tent city in Victoria seems to be a poverty stricken situation when in actual fact the city of Victoria has been trying for decades to help these people. The Canadian government funds the hospital settings, where there are lots of mental health and addictions services provided to people with and without income for free. We live in a democratic system where the majority of the tax-payers often over-ride the minorities. This is the kind of political system the majority of Canadians want. Democracy is freedom. Some theorists believe that the homeless want to be homeless. Others believe it is a medical condition, perhaps schizophrenia, or perhaps addictions or a combination of both. There are laws in British Columbia which place people with schizophrenia and addictions into both a law system and a medical system. These two systems lead to a government Canadian financial / disability system as well. The individual becomes taken care of by the state. Tent city is the birth of all of these elements combined together. The physical appearance of tent city looks like a cocoon, it is like all the inhabitants are sedated and in a sleeping state, wanting to arise again.
0.01% of the General Population
This Communication Model is a model of care that is intended to help an individual who is experiencing mental distress. It is model that does not cost anything, does not offer advice and does not promise anything. It is a model of acceptance and non-judgment, and intended for the 0.01% of the general population with treatment resistant psychosis.
Method: When an individual with mental distress communicates his/her feelings in a confidential manner what often happens is that the acceptance of the individual leads to an empowerment. This empowerment leads an individual to want to take responsibility for his/her own destiny. The Communication Model works in a very contradictory and paradoxical way & at the same time in a very positive way.
The Communication Model is intended to pick-up where Sigmund Freud left off. For example, in the past Sigmund Freud believed that a person with schizophrenia could not be counseled. This concept lead to individuals with schizophrenia currently being medicated through the hospital + general practitioners and sometimes receiving psycho-social care in the community.
The current psychiatric system is built on Sigmund Freud’s concept and I want to add to that and focus more on the individuals emotions. I believe that it is through communicating with an individual with refractory schizophrenia that drives individual self-mental-change.
Throughout my volunteer work and internship work at the British Columbia Schizophrenia Society in Victoria, I noticed that individuals with serious mental illness, who were medicated often said two important statements: [1] that they wished that they could feel again – because the medications were making them feel numb and [2] that even though they were taking medications they were still experiencing distress inside of themselves. These two statements made me realize that there is a need to focus on the emotions underlining the symptoms. It was the wish of individuals with serious mental illness – out of their own testimonies – and it is these testimonies – that is one of the main reasons why the Communication Model was born. Furthermore, even though it is mentioned through the Medical Model that medications for schizophrenia are effective – the opposite side of the same coin is that it is a known fact that the medications do not work for a very select group of treatment resistant individuals despite proper compliance and the adherence of strict and regimented instructions and the following of medications schemas. It is called Treatment Resistant Psychosis / Refactory Schizophrenia and the Communication Model is intended to try to help these very select specific individuals. During my Interprofessional Mental Health and Addictions post degree program diploma at Camosun College in Victoria British Columbia Canada, I conducted a literature review into Schizophrenia and the Canadian Justice System – and with more than 400 peer academic research references indicated that many seriously mentally ill (SMI) individuals were DSM diagnosed and in jail. To me, that means that the Medical Model did not work well for them – seeing that the individuals were now behind bars.
Treatment Resistance Psychosis is something that is not the fault of an individual. Instead it is the opposite. Treatment Resistant Psychosis means that these marginalized individuals often get stigmatized by psychiatrists and medical doctors because the psychiatrists and medical doctors do not know how to deal with this very specific group of people. Because the medication and the Medical Model seems to be working for most people with schizophrenia (estimation of 0.99% of the general population), often what occurs, is that psychiatrists and medical doctors will turn a blind-eye to this group of people, (estimation of 0.01% of the general population) because the majority of individuals seem to be receiving treatment that works. The estimated 0.01% general population will have schizophrenia symptoms, for example paranoia, however they will be labeled behavioral versus symptom-related. This leads individuals to fall through the cracks and hence often become homeless or in the Canadian jail system.
Would it not be logical if the Medical Model started to focus on the 0.01% of the general population treatment resistant psychosis individuals (this percentage is an estimation) versus the 0.99 % treatment successful psychosis individuals – or is that not feasible nor effective according to the Medical Model? Is the brain so vast that it is impossible, with any exact precision to pin-pointing an exact area to be targeted? The psychiatrist often needs to adjust the medications of any individual with serious mental illness many times before being able to access if they work.
The Communication Model is a tool that is intended to help the individuals, the hypothesized 0.01 % of the general population, with treatment resistant psychosis, through a unique way of communication. This unique form of communication is the symbiosis between the practitioner (myself as chief operator of the Communication Model) and an individual (experiencing treatment resistant psychosis symptoms, which in the realm of the Communication Model are referred to as emotions versus medical symptoms).
The aim of the Communication Model is to relieve pain by drawing and talking and linking into each others psyche in a humanity approach. There is no financial gain, no promises with be made and no advice will be given. At the same time, it must be mentioned that a trained Mental Health and Addictions Practitioner should conduct the Communication Model. As the Communication Model is intended for Refractory Schizophrenia solely. There is a unique communication symbiosis that develops and this is a very specialized skill – gained though lived-experience – combined with a Bachelor of Arts degree in Arts Policy, Management and Education, specialization Art Education combined with a post degree diploma in Interprofessional Mental Health and Addictions. There is a hyper-focus on treatment resistant psychosis intermingled with Existentialism, Individualism and Personalism. The Communication Model is to be conducted with safety in mind.
©TCM
Written by Annuska van der Pol, BA, PDD-IMHA
Mental Health and Addictions Practitioner
Victoria, BC Canada
Note: the number 0.01% treatment resistant psychosis of the general population is a number referenced in peer-academic material
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Introduction – 11 layers of treatment resistant psychosis – discovery of a formula
The Communication Model is a tool to be used to help individuals who suffer from treatment resistant psychosis. Treatment resistant psychosis can be defined through the standards of the Medical model. Treatment resistant psychosis has eleven (11) layers to it. It consists of specific symptoms stemming from serious mental illness, such as Major Depression, Bipolar Disorder and Schizophrenia. What makes treatment resistant psychosis different than regular psychosis is the fact that even when medications are being applied the symptoms prevail.
Eleven (11) layers of treatment resistant psychosis
Solution-focussed treatment resistant schizophrenia
The Communication Model is a friendly non-coercive intervention that is intended to provide short-term alleviation of mental distress, like applying First Aid to someone who had an accident.
It is a way to de-escalate mental distress a-la-moment. For example, let’s say a person with schizophrenia is standing on someone’s property and screaming at the oranges to stop talking to him, the neighbours telephone the police and the police arrive on-scene, as well as the Mental Health and Addictions Practitioner with a clip-board and paper. What would happen is the police and the Mental Health and Addictions Practitioner will arrive on-scene together and they will approach the individual with serious mental illness together. The first step is to find out what happened. When the individual shows signs of symptoms of serious mental illness, then the Mental Health and Addictions Practitioner will step in, and start to verbally communicate with the individual experiencing the mental distress. Once the verbal communication indicates delusions, hallucinations, flat-affect, bizarre language, disorientation or confusion – then the first step would be to acknowledge the emotion that the individual with SMI is experiencing. Then when the situation on the scene is de-escalated, then the individual in question would be asked if he / she would like to participate, out-of-free-will in the Communication Model. On consent, the Communication Model will be applied. That means that the feeling and the experience of the individual in question, will be explored through words and through the creation of an abstract drawing which is the intervention of the Communication Model by application of the triangle method. This process is intended to calm the individual with SMI down and alleviate any emotional distress, to the level of retaining logic and rationality. Once the Communication Model has achieved the containment of the psychosis out-break (psychotic break) then the next step would be to determine if the individual has supports that can help him / her or if the individual needs to get emergency psychiatric medical treatment. The police and the Mental Health & Addictions Practitioner will then drive the individual to the chosen destination to receive the secondary treatment.
Conclusion
In order to conduct this level of connection between person with serious mental illness and Mental Health and Addictions Practitioner one project needs to be conducted. This project involves flying to Kingston Ontario and engaging with one of the four hundred and nineteen (419) currently mentally ill diagnosed inmates, who are Federally incarcerated. The concept is that the Mental Health and Addictions Practitioner will apply the Communication Model, on consent of one prisoner. It is the intention to apply the Communication Model for fifteen (15) hours, 5 hours per week for three weeks. Then after this, the prisoner will then be instructed to share this approach with one other prisoner. He then teaches the method to the second volunteer / incarcerated / Federal / prisoner / who is diagnosed as being mentally ill – and so-forth. The process is intended to create a chain-reaction in the prison cell improving the quality of individualism and at the same time creating a sense of community by sharing situations.
In order to do this part, there needs to be some organizing (letter to the executive director of the Federal Jails, finding a volunteer who out of free-will consents to participating in this concept. Then once that is secured, organizing dates to conduct the Communication Model, organizing a place to stay there for three weeks, organizing a rental vehicle, organizing time slotted schedules, conducting everything and then returning back to Victoria British Columbia after completing the task).
Estimated costs: to be determined
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When a doctor is working in an emergency care unit, he/she is expected to keep his/her personal feelings contained. This is called Empathetic Detachment. Empathetic Detachment resembles Dissociation in some ways. For example, when a victim enters the emergency room and a doctor needs to operate, the doctor is expected to act professionally; contain personal feelings and thoughts; and hold ones own personal opinion to him/herself. Empathetic Detachment is a state of mind which seems to contain the personal judgement of a medical situation – by professionally focusing on the medical procedures at hand.
Dissociation is a state of mind where when one is faced with either real or perceived terror, one freezes into an alternative state of mind in order to [1] cope better with the situation and also [2] in order to protect oneself from real or perceived danger.
There is a fine line between empathetic detachment and dissociation. The one main difference between the two terms is the context, for example when one is an expert in the field of medicine, psychopathology, mental health and addictions, and one is performing a professional operation, often one uses empathetic detachment to perform a complex incision; whereas if one is experiencing a personal real or perceived threat in society one could apply the dissociation.
A similarity between empathetic detachment and dissociation is the feeling it has on the psyche.
Another difference between empathetic detachment and dissociation is that empathetic detachment is intended to purposefully do good consciously i.e. perform surgery, analyze a complex human situation or comprehend human ambivalence versus dissociation which occurs as a conscious or unconscious personal state of mind based on a identified or non-identified personal trigger.
The notion of empathetic detachment does not seem to cause long-term harm to an individual, if one applies self-care. However with dissociating that is not always the case. Dissociating could originally have been a beneficial coping mechanism at the moment, when the choices where either fight, flight or freeze, however in the long-term, if dissociating is not acknowledged and explored, it could become a chronic component with a serious mental illness symptomology.
The Communication Model Approach is both a professional and a peer model approach with compounds of each. This means that the practitioner juggles between the two-states as a matter of navigating between symbiosis and strong emotions of serious mental illness. Self-awareness and the ability to self-identify feelings of empathetic detachment and dissociation are key to applying the Communication Model effectively.
© TCM
Reference:
Hart, Bernard (1958) The Psychology of Insanity. Cambridge University Press p. 41-50.
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© TCM 2013
Currently in British Columbia, there are a number of individuals with serious mental illness in the jail system. Having mental illness and being in jail is just wrong. A person with serious mental illness should be treated in a humane and caring way and not in jails. Mental illness is not something that can be treated in the prison system. Coercive care is not acceptable for medically ill individuals. Serious mental illness needs to be treated in a community where all individuals within the community have a sense of what serious mental illness is. For example, if all individuals within society were educated into what serious mental illness is, then this is half the battle. If all citizens within a society could identify the traits of serious mental illness, then the individual suffering from serious mental illness him/herself will feel more accepted and more liberated. This new feeling of acceptance would then ultimately eliminate the judgment or the stigma currently associated with serious mental illness today – and it would break down the walls that many people in society have regarding the misconception of serious mental illness, such as schizophrenia.
The solution as to how this can be achieved is simple. The answer resides in The Communication Model, as one system of care. The Communication Model is an intervention that all individuals can apply in order to help another individual who is experiencing serious mental illness traits, such as psychological distress, pain and agony.
The Communication Model (TCM) is intended to help society understand and help individuals who suffer from serious mental illness. It is intended to bridge the gap between stigma and understanding. The Communication Model is intended to eliminate the fear and the prejudice often linked to an individual who has a serious mental illness. The Communication Model is a Humanity Model, based on the idea of acceptance and non-judgment. The helper listens to the individual while creating an abstract drawing. The abstract drawing becomes somewhat of an impartial third party – like a witness to the interaction between the helper and the individual in pain. The Communication Model is the opposite of any hierarchy system structure. It is the dismantling of the hierarchical system structure. It is a Model of care intended to be based on full equality and a full decentralization of any kind of hierarchical power oriented system. This is the one hundred procent (100%) opposite to the current hierarchical system structure. All hierarchical systems are not optimal. In fact each hierarchical system leads to some marginalized individuals in the system falling through the cracks – whatever the system is. When it comes to seriously mentally ill individuals, who really are medically sick, this is absolutely unacceptable treatment and it is offensive to let medically ill individuals be hung out to dry by being locked up instead of receiving adequate medical treatment. Driving the Communication Model forward is the importance of the need of good medical care for example, the seriously mentally ill individuals in jail – should receive justice and equality versus injustice and inequality; they should receive medical/psycho-social care/ humanity care in the realm of the community in contrast to behind bars.
The Communication Model is intended to break the walls of power that have been in existence for the last two thousand years (2000 years), as it is the hierarchical power structure which, is, at least to some extent responsible for the existence of serious mental ill people landing in jail today.
The Communication Model is a model that is free of charge. There is no money transaction involved. There is no payment. It costs nothing. The Communication Model is based on moral, spiritual, ethical, personal, private and confidential values. It is based on a mutual respect, a mutual understanding, it is dignity oriented, human rights oriented, non-discriminatory, non-prejudice, non-judgmental and it is an Acceptance Model. The aim of The Communication Model is to help the seriously mentally ill receive a higher quality of life by providing humanity based communication.
In effect, The Communication Model is intended to have a Domino-effect on society. The change is intended to take place in a gradual but consistent fashion, starting in the jails and ending-up amongst all layers of society, hence changing society in a gradual and apparent progression, from the bottom up.
It is the intention to go into the jail system in Victoria, British Columbia. Here, the plan is to teach an inmate, who, out of his/her own free-will, comes to see the helper, to talk about his/her own personal psychology distress. The Communication Model would be applied. The inmate will receive up to fifty (50) sessions. His/her psychological distress will be transferred into numerous abstract drawings over the course of the fifty (50) sessions. The abstract drawings will be protected and placed in a file after each one (1) hour session. The abstract drawing is part of a confidential communication. Each session will be based on a non-judgmental, acceptance and Humanity Model. A system of care based on mutual understanding and mutual respect, and based on non-discriminatory and non-prejudicial components. What often occurs within the application of The Communication Model, is that the individual experiencing the emotional distress, often changes. Somehow the abstract drawings, deters his/her attention away from their own emotional pain and hooks into a deep dimension of humanity. It is within this deeper dimension of humanity where both behavioral change and structural change seems to occur. For example, as the session progresses, listening with empathy occurs and the abstract drawing is created, as this happens – the individual with the distress seems to shift their soul from victim-hood to one of empowerment. The shift is subtle but noticeable. The crying often stops. The violent words of aggression and discontentment change into a gentler intonation, where trust develops into a deeper confidential trust element, constituting a substantial element of pure safety. This feeling of profound safety enables a bond to be created in an ever-lasting humanistic relationship. This profound element of safety becomes the anchor and the life-long lasting rapport which enables positive rehabilitation and the openness and willingness to change – a change that is only unique to the one specific individual seeking the help – the one with the emotional distress. The abstract communication drawing locks in the bond and holds it together like glue. It stands the test of time, like building blocks for a brand-new foundation of a newly discovered self.
Throughout the following sessions, the helper will take out the abstract drawings from the session prior, providing the continuity of the memories/emotions of the previous session. Creating this continuum of care is needed to make a positive rehabilitative change.
It is the intention that after fifty (50) sessions with the inmate in the British Columbia jail system, that the one individual with serious mental illness will then be equipped to teach The Communication Model to some one else who comes to him/her out of his/her own free-will and who is experiencing his/her own emotional distress. The vision of The Communication Model is that inmate A will be able to help inmate B in a very effective fashion, and hence applying The Communication Model components learnt for the fifty (50) sessions. This application of The Communication Model is intended to relieve the tensions amongst all inmates living in the jail environments over time. Instead of fighting, becoming aggressive and acting out in violent behavior – The Communication Model is intended to alleviate the pain, the distress and the hopelessness within the hierarchical jail system structure, with special attention to the hierarchical jail system structure surrounding the inmates themselves specifically – as, within the current jail system structure, individuals with serious mental illness are considered to be on the bottom of the hierarchical rankings. This Communication Model is intended to change the power struggles amongst inmates living within the jail system through an equality based system model. One based on a peer inmate helping another peer inmate to overcome personal despair. Once each individual inmate starts to help each other as best as they can, each prison inmate will become valuable citizens of society and will start to lead by example, which would lead to teaching The Communication Model to the prisons guards and the probation officers and psycho-social care workers, mental health and addictions practitioners and doctors, and family-members – that rehabilitation amongst the so-called most deviant of individual is possible.
It is only by targeting the most unlikely to change, according to current societal hierarchy standards – that one can instigate real change within a society. The source is jail inmates. It is believed that all jail inmates, with or without serious mental illness have the ability to change, rehabilitate them selves and actually, lead productive lives. It is believed that each inmate to be a value factor to developing a more positive and a more constructive society as well as contributing to their own individualized quality of life. A society and quality of life based on acceptance, non-discrimination and emotional intelligence versus the hierarchal power oriented approach.
Written by Annuska van der Pol, BA PDD-IMHA
TCM Mental Health and Addictions Practitioner
Victoria British Columbia, Canada
P.O. Box 8825, Victoria, BC V8W 3S3 Canada
2005como@gmail.com
This article is based on research of more than four hundred (400) peer-academic articles in 2012 / 2013. Keywords for the research were: schizophrenia, jails, Justice System, prisons, Psychiatry, Social Justice, Law.
Example of a Communication Abstract Drawing 2013
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anuvdp 