Crazy People Changing the World

This week, I watched a couple of patients talking during a group therapy session, and what they said made me think. They were having a discussion about how to regulate your mood, when this young man said the following:

  • “You’re sad? Medicate that. You’re happy? Medicate that. If you lost your grandmother, and you’re grieving, then you’re depressed. It’s like we’re not free to feel anything.”

The therapist tried her best, replying:

  • “Well, there is research that links too much grieving to depression.” The patient scuffed: “Humph. Research. Who’s to say how much grieving is enough?”

At the crux of person-centered care is understanding the person with whom you’re working, collaborating with him, and helping him get to where he decides is the destination. Medical care is often associated with authority, “the doctor knows best”. At times, it can be intimidating for a patient to disagree with his doctor; after all the doctor has access to all medical information, and the patient doesn’t. It is the duty of the medical provider to learn to communicate in language that the patient can understand, so that she can make an informed decision, based on her values. Sharing information is sharing power.

In behavioral health, creating the partnership that person-centered care demands, requires the acceptance that a person with severe mental illness can decide what is best for his or her care. Years of stigma stand as huge obstacle to be overcome. In general, people don’t see chronic illness as something of which to be ashamed or embarrassed, unless we’re talking about mental illness—in that case, “hush-hush”.

Mental illness is something so intangible, particularly for the patient. What we see as bizarre behavior, or non-functional, to the patient is part of who they are. The concept of illness is associated with pain. Mental illness not always comes with pain. At times, it comes with an increased sense of power and energy, as in manic episodes for example. It is hard to convince someone they are sick when they feel energized and capable of conquering the world. Or when they feel they have special powers and can read your mind.

Developing person-centered care in behavioral health, demands that you meet the patient where he or she is. It demands that you accept that perhaps they don’t want to feel “normal”, and that life-style that is not typical can be ok. As provider, our duty is to help create safety and support. As a behavior analyst, my role is to design an environment that will support growth. It is my duty to help the patients develop the skills they choose to make their lives richer. It is my duty to help organizations understand and create behavior supports. It is my duty to be a vehicle for partnership.


“The people who are crazy enough to think they can change the world are the ones who do. “

Steve Jobs

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