INTAR India - day 2

On Sunday 27 November 2016, at 9 AM the second day of the INTAR-conference started, again with some delay. INTAR means International Network Toward Alternatives and Recovery. The conference was organized by Bapu Trust, http://www.baputrust.com/index.php/news-networks/intar-india-2016 . Today’s theme was: Cultures, communities, and responses.

We were welcomed by Liam MacGabhann and Yayasree Kalathil, who introduced the speakers of the first Plenary Panel on: Peer support and community mental health practices for people in extreme states, led by Bhargavi Davar.

Mary O Hagan (famous user/survivor activist, Peerzone) presented 10 lessons she had learned in 30 years of activism. She spoke about seizing the “Berlin wall-moments”, and surfing the political waves. And she spoke about having clear targets, backed with stories, understanding your oppressors, and your own privileges, and the importance of communicating viable alternatives, and the power of human rights based argumentation (nobody can argue equality is “wrong”). One of the most important lessons she stressed, was to engage with others outside the mental health domain to find more support, and to work both inside and outside the system, to avoid being co-opted. She also stressed the importance of taking care of your own wellbeing and to allow yourself to take a break when you need it, and not feel guilty about it. She ended by quoting: “Blessed are the cracked for they shall let in the light”.

Peter Stastny (psychiatrist) also shared his lessons learnt over the past 30 years in supporting peer workers in the mental health care system. He spoke about the proven value of peer support, and the need to give space and power to the rise of peer support, and to empowerment of peer support workers. An increasing number of peer support workers are being employed by the mental health care system, and there is a risk to their independence and ability to make a difference by advocacy, because of their employment position. They risk to be marginalized and to become part of an oppressive system (co-optation). Peer workers in alternative services (such as respite and runaway houses) are often in a more equal position, and can contribute significantly to advocacy to avert harm and to promote recovery. He concluded that peer support workers should not take part in coercion or in “monitoring treatment-compliance”, but they should rather focus on prevention, averting crisis and coercion, and train people to offer support in serious crisis. “Be where you can make most difference” was his final advice.

Chris Hansen (famous user/survivor activist) spoke about Intentional Peer Support (IPS). First she shared her personal experiences, and stressed the important conversations with peers in the mental health care system. Psychiatric question-lists are fishing to find “what is wrong”, and that makes one feel trapped, small and lost, while peer support is exploring how to be in a relationship of support and connection, through hard times and good times. Inspired by the work of Sherry Mead, Chris Hansen started a movement for Intentional Peer Support (IPS), and “intentional” means developing a relationship, to connect, support and learn and grow together, somewhat like mutual mindfulness. It is not about “help” but about liberation. And not about the individual, but about relations, and connecting to a world-view and knowledge in life. It is not about fear, but about hope. Intentional Peer Support (IPS) has become a well-known and widespread support practice, also see http://www.intentionalpeersupport.org/

Then an interesting discussion took place, amongst others, about 3 levels of peer support workers: those working in the communities at grass roots levels (unpaid), those who work in organizations of peer run services (independent alternatives), and those working inside mental health care systems who are at the highest risk of co-optation. This underlines the value of overall umbrella organizations for all peer workers, to collectively protect the integrity of peer workers against mainstream dynamics.
An interesting question was: what would you do different now, in hindsight? Mary O Hagan answered she would seek more allies outside the mental health domain, in terms of people with power and influence who are willing to support the cause. Peter Stastny said he would focus more on independent, non-governmental initiatives, and “not trust the hand that feeds you”. Chris Hansen said she would focus more on supporting and nurturing peer support networks to support the daily practice of IPS at grassroots levels.
Another question was: How to find an entry point for community development, because mental health laws focus only on medical domains, which in itself poses a barrier to the development of community based mental health support services. As an answer: the Sustainable Development Goals could be a point of entry for community development.

It had been a very interesting morning session.
After the coffee break, I joined the Workshop on: UNCRPD, extreme states and community mental health.

Kavita Pillai (Bapu Trust Project, India) spoke about the community based support project of Bapu Trust in Pune. This is a grassroots initiative to support persons in their psychosocial wellness and wellbeing, driven by non-medical views, offering space for self-help, peer support and other volunteers. The focus is on building bridges to inclusion in the community. They use the 8 Point Recovery framework (comprising: self-care, nutrition, social justice, families, groups, individual support, health care and social capital), and they have created an alternative (non-medical) list of support options for wellness. The support provided is not organized as a module, but depends on the available offer, and is mixed and matched with the person. “There is only one way to provide support, and that is the way chosen by the person”.

Sarbani DasRoy (Ishwar Sankalpa, India) spoke about their work in the slums of Kolkata, where the Ishwar Sankalpa organization runs 2 day care services and 2 night shelters, where they provide support to homeless and excluded persons, who often have a range of support needs, including immediate needs for self-care and daily needs (washing, food, clothes), and health care (illnesses, injuries), as well as other basic needs, such as housing, income and social acceptance by the community. The Ishwar Sankalpa organization also reaches out to the community, to overcome stigma, for example negotiations with certain barbers who refused to touch persons. They also reach out to volunteers in the community, like tea-sellers (who generally know everybody in the community), asking them to support the integration of a person in their local community. This renewed social connection breaks the loneliness, which basically brings spontaneous changes in self-care. 60% of the persons spontaneously start helping the tea seller, and some eventually become support workers themselves. It is a way of opening up local communities for inclusion and social re-acceptance. “The joy of giving” is an important feature of culture in India.

This was very interesting workshop. Again it was out of the medical box. It was about addressing practical social needs for nurturing personal wellness and inclusion in communities, which offers a clear alternative to the medical model approach. Complete with alternative parameters (such as the 8-point recovery framework, which includes clear social determinants). I found this extremely meaningful and inspiring.
Also, it gave me a closer view on the situation in India. Many times I thought about what I had seen in East and South Africa, and the differences and similarities in practices at various places all over the world. It is giving rise to deep philosophical thoughts and questions about how to organize the world better.

Then it was lunch time, with again a nice buffet to choose from, - in itself also giving rise to geopolitical thoughts and questions.

The afternoon started with a Plenary Panel on: Culturally informed resourcing in response to crises.

Michael Winkelman (researcher on shamanism) spoke about biological resourcing, natural psychology, shamanism and traditional healers, addressing universals and the common bases of shamanistic therapies. He came from a global north perspective (USA). Varieties of shamanism, magic healers, mediums and witchcraft have existed in all cultures. A classic definition of shamanism is about entering an altered state (ecstasy), to communicate with spirits on behalf of the community, which was traditionally achieved by drumming, singing, dancing, sleep deprivation, pain, sensory stimulation and other rituals, as well as by the use of various substances. Primates also show drumming and dancing rituals, as a deep natural communication tool, enabling expression, social coordination and bonding together as a group, which enhances the functioning of a group for survival. Collective rituals like drumming and dancing, communal bonding and altruism (ego-dissolution) all produce neurochemicals that enhance wellbeing (like serotonine and opioid related bonding). Drumming is found to be useful in substance abuse treatments. Hypnotic capacity appears to be a hereditary trait. Altered states provide space for new synchronisation of behaviour, emotion and thought. Altered states also provide enhanced access to unconscious information, including by visions and sounds. In the north-western world, access to the remnants of shamanism and traditional healing has been lost at large, mainly by systematic killings. Yet, these methods are truly valuable, and need to be recognized as such.

Kwame McKenzie (psychiatrist and researcher) spoke about social resourcing. Within the current economic social structure, persons are individually held responsible for their wellbeing, and when they don’t succeed, a diagnosis is created, and a parallel system is applied to “fix people”, instead of fixing the community and its structures. Mental health care represents the costs of the way we organize society, the costs of exclusion. It is now time to reorganize and rebuild the society, and to aim for full inclusion. Projects such as Housing First, and Basic Income have proven to be far more effective in supporting wellbeing than the individualized medical model tools. An increasing number of pilot experiments and studies is currently being carried out on Basic Income, especially in the light of overall reduced job opportunities by automatization. This is a promising development which may offer a chance to turn current negatives into positives. The focus is shifting from “including” social determinants in mental health care (social model), towards “addressing” social determinants and “fixing the system” by community based support (human rights model). Similarly as how physical health depends on social determinants (hygiene, nutrition, lifestyle and so on), also mental health and wellbeing depends on social determinants.

I found both presentations very interesting and inspiring.
Several questions were raised on Basic Income, and its (in)affordability in developing countries. It would require a change of existing economic models, which are to some extent virtual. Economy was originally designed to facilitate as many inclusion as possible, yet it got off track. Again, the current imbalances may offer a chance to turn negatives into positives and to achieve the needed change.

Also, there were quite some questions on traditional healers and shamanism, and the wide, unregulated range of practices, ranging from good to bad practices. Certain practices and exorcisms may be violent and abusive, while other practices and initiations may be helpful. Yet, there is hardly any data, regulation, monitoring, or research to the outcomes of the wide range of traditional healing practices. This is a complex issue that requires much more attention.

A critical remark was made on how the presentation of Michael Winkelman had had a “western scientific perspective”, centralizing the brain functions and neurobiological effects of drumming, and ignoring the spiritual meanings, which is often still labelled by western science as “superstition, delusion or false beliefs”. In exactly this way, medicine and science have wiped out shamanic practices…

After this very interesting session, there was another coffee break. And then, for the last session of the day, I joined the workshop on spiritual and indigenous healing.

Shubha Ranganathan spoke about pilgrims at a religious shrine. She gave an example of a woman, who had a strange headache. She was eventually referred to consult a psychiatrist, who diagnosed her within minutes, based on shallow questions, as having a depression, and prescribed her medication. There was no meaningful contact with the individual or any other support, except medication. The pilgrims experience the clinic as only a medication dispensary, and turn to the shines for other support.

Sabah Siddiqui also spoke about the clashes with biomedical science and spirituality. She gave an example of a woman with psychosocial problems, who stayed for a long time at a Dargah (religious shrine) as a place of refuge. She was eventually taken to a hospital, where they gave her horrible ECT treatment. Eventually a physical illness was found, for which they gave her medication. Yet, the medication and side-effects only made her more sick. Eventually she felt that everyone was failing her (spiritual, medical and psychiatric support). She eventually was homeless again, and returned to the Dargah, which was her only place of refuge. Obviously the existing models do not match the needs.

Kimberley Lacroix read out the findings of her study on “community engendered alternatives to community mental health”, which aimed to identify pathways of mental health care in urban slum communities, and which ‘alternative’ spaces are already available. In India, there is a wide range of alternative and spiritual practices in every region, including in Dargahs, temples, individual healers and self-help groups. Different conceptualization means different routes, such as for example regarding internalization and/or externalization of experiences (psychoanalysis versus karma). The rich variety of alternatives presents opportunities to study and learn more about these alternatives.

Michael Winkelman spoke about the so-called “sacred medicines”, such as Peyote, LSD, Ibogaine, Ketamine, Ayahuasca and Psilocybin. These substances have been used by traditional shamans, and research shows these substances may also be useful for interruption of addiction, by a mystical experience leading to transformation.

After the workshops, there was another brief Plenary summary and round-up of the day, which was followed by an invitation to join the party outside, with music , a bar and a buffet, as a Thanksgiving-party. It started with a drumming circle of participants, followed by a band, and ending in karaoke. It was a really great and joyful evening. I was grateful to meet so many interesting INTAR-participants, I learned so much, and got so inspired. I also had fun with some Indian kids who passed by, and who really loved my hair. A really joyful evening.

Again, I decided to postpone blogging, and to use the social time to the maximum. I went to my room just before midnight, and finalized the preparation of my presentation on Family Group Conferencing. After that, I went directly to sleep, since another big day was coming up.