Suzanne Kryder talks with Sanjeet Sihota a licensed social worker, who was also diagnosed as having mental illness.

SK: Sanjeet, our program is about peacemaking and non-violent conflict resolution. We want to know what the conflict is around mental illness. It seems like it could be about personal conflict or in the healthcare community or in the culture. Where do you feel the conflict is?

SS: The conflict can be in actually all three of those areas. For me, part of the conflict within ME was whether to disclose or not disclose, what type of relationship to disclose, when to disclose, all those things came in. I think that that comes into a lot of people’s situations because it’s a stigma that’s out there that really has an impact. When you share, you could be defined by your illness as opposed to people looking at you as a whole person. I think that’s a very sensitive issue that each person has to know how to navigate.

SK: Sanjeet, what do you want to say about your own mental health?

SS: In terms of my own mental health, the conflict that I had was whether to take medication or not. I went through three hospitalizations struggling with that decision. Eventually I came to terms and took it because I had to stay out of the hospital to build any sort of life for myself. It was not an easy decision to come to.

Having said that, when I finally got a close relationship with somebody, somebody who could transcend a professional relationship and offer me love and care, making it their job to see me get well and walk alongside me in the community and help me to garner the things that I needed to get well again, it was within that relationship that I was able to get well. Had I not been offered that, I think I would have still been stuck and hopeless. Somebody carried hope for me until I could believe in that hope for myself.

SK: Sanjeet, you’re a trainer for LEAP. What is LEAP?

SS: LEAP is a method of communication that builds a type of relationship with somebody that is emotionally close. LEAP stands for listen, empathize, agree, partner. For example, if somebody says to you, “I’m not sick. I’m not mentally ill. I don’t need these damn medicines. What I need help with are the people upstairs who are flushing the toilet to communicate with those who are trying to kill me.”

Instead of saying that’s delusional or a hallucination we need to put you on meds, you don’t go that route. You say, “Let me see if I have you right. You’re not sick. You don’t need these damn medications. What you need help with are the people upstairs who are flushing the toilet to communicate with people who are trying to kill you. Did I get that right?”

Without that, you can’t build a relationship because that’s what’s most important to the person. That is what is on their plate. That is what is more distressing. To build any sort of relationship with them, you must make their opinion understood first and foremost.

You could say, “That sounds terrifying. Yes, it’s really scary. If I was in your shoes, I’d feel exactly the same way. I think anybody would.” That’s how you start to build a relationship. It’s based on ultimately respecting their opinion first and foremost before saying anything about what you think. Once the relationship is built to a certain point, you can start to share your opinion and they take it with much more weight because it has developed through this relationship where they respect you because you respected them.

There are always areas to agree on whether that’s “Let’s figure out how you can keep your apartment. Let’s figure out how you can get back to school. Let’s figure out how you can work. Those are the things that are important to you. Let’s work together and see what best helps you to do that.” You don’t mention anything about decreasing symptoms. It’s more like, “The aliens are really bothering you. They’re saying that they’re going to harm you. Would you like to take something to help with that anxiety? I see how overwhelming it is.” You don’t use the language that professionals use.

SK: I love “should’s.” I have a long list of how the world should be. I know that it might not be there yet. Let’s say someone is listening to our program right now and maybe they think that they have a mental illness, or they think a family member or a friend has a mental illness, what should they do?

SS: In my opinion, number one I would get the book; “I’m Not Sick. I Don’t Need Help” by Xavier Amador You can learn the best communication style to best relate to your loved ones. That would be my suggestion first and foremost. Communication is the key. The style of communication is absolute key. That will teach you the type of communication to relate to your loved one.

SK: Let’s imagine you used LEAP for three months and suddenly, the other person is becoming violent. What do you recommend?

SS: In that situation where the individual becomes violent, you have to protect yourself, you have to protect them.

SK: Does that mean that you would call the police?

SS: You would call the mental health crisis unit. They are trained in assessing people who suffer from these sorts of conditions. Sometimes if there is violence, a police officer trained in mental health could come along as well as a social worker or MFD who assess the situation. Violence is one of the criteria that you take someone in on grave disability or suicidality. It’s not easy to get someone hospitalized. It’s pretty difficult, but violence is a black and white issue.

SK: Sanjeet, this is a hard one for me about suicide because I have a disability and I was suicidal for a long time. I only told one friend because I knew she wouldn’t freak out. It seems scary. Then we could get into a philosophical discussion about whether or not people should kill themselves. They shouldn’t kill other people, but they’re killing someone if they kill themselves. My question is how does one know when to intervene?

SS: One thing that they say is based on prior suicide attempts. Another thing they say is whether or not an individual expresses a plan that they have in place to attempt suicide. Those two things can really play into it. I’ve heard a lot about “Do you have a plan in place?” If a person really articulates a plan, then you should take action.

My own story, I can tell you that I went through periods where I definitely felt suicidal and that that was the only solution, but I never had a plan to do it. There were thoughts that came and went, but I never put together any sort of plan about how to do it.

SK: Sanjeet, it sounds like some kind of hierarchy that we’re continuing in our culture in terms of who gets care, who doesn’t. Rich people get care. Poor people don’t get care. It seems like a hierarchy. It seems like every culture has some sort of cast or hierarchy system.

SS: Yes, it’s definitely true when it comes to mental illness. The type of care, the quality of the provider are so important for a person’s recovery. A lot of times, unfortunately, when people can’t afford that, the quality of care is poorer and as a result of that, the ability to recover is more difficult. It should be a level playing field, but unfortunately, that’s not the case when it comes to mental health care.

Suzanne Kryder Interviews Theda New Breast, master trainer for the Native Wellness Institute

SK: Theda New Breast, tell us your tribe.

TNB: I’m what you call the Blackfeet and we’re part of the, Siksika, the Blackfoot Confederacy. We have three tribes in Alberta and 1.5 million acres in the state of Montana known as the Blackfeet Nation.

With Native Americans, the colonization process and the racism and sexism, agism and that kind of infiltration into our families has caused a certain kind of mental illness that’s treatable. It has to do with oppression. To bring back the mental health, you just undo those things in that order, undo the formula.

A lot of it is bringing back rights of passage, bringing back the language, bringing back the storytelling, bringing back the genesis in a way that their ancestors, their stories of creation, their ancestor stories of behavior.

Most tribes have many stories that children listen to. They start with lullabies. They sing them lullabies and then they start telling them stories. It’s how kids watch and play video games now, they learn how to behave. You can undo the mental illness with the culture.

I learned prevention very early. I’ve been doing this for four decades and I’ve seen people who have diagnoses like manic depression, post-traumatic stress disorder, chronic fatigue, extreme depression, even schizophrenia and lupus. Natives get these types of diagnoses of the body, the mind and the spirit.

I can see as they heal, they put away the drugs and the alcohol, they start to sun dance, fast, go into steams. They relearn their language. They start dressing indigenous. They get their native name rather than their IRS name that we have to use with the social security number. They heal. You no longer see the mental illness anymore once they start to reclaim their culture.

SK: Let’s talk about the Native Wellness Institute. I know you do lots of work for them. You also did a documentary called Why Women in my Family Don’t Drink Whiskey. In the documentary, you say there was a “trauma tattoo on my soul.” I’m guessing that other people, Natives, Indians have a trauma tattoo. Talk about what the Native Wellness Institute does for Indian souls.

TNB: What you’ve described sometimes is what we’re finding with epigenetics. Epigenetics is the study of what is brought down in your DNA.

For example, in a lot of our tribes, in my tribe, 150 years ago we had the Bear River Massacre. Gatlin guns were set up and they just murdered 95% of a camp of families in teepees.

If you’ve had that type of trauma with grief and loss like you also have here in Alaska, that can leave a genetic marker. That’s what I’m calling the “tattoo.” If that is brought down, then you are genetically hardwired to respond to that trauma.

That is being studied. A good way to explain it in a short story is some of the science around it is we don’t do experiments on humans, but I think they do in prisons.

They’ve done a lot of mice studies where they let the mouse smell cherries and they shock the mouse at the same time. Every time they have the smell of cherries, they electrically shock them, which is very painful.

Then the study shows that when those mice have offspring, they never shocked those offspring, but just let them smell cherries and when they smell cherries, they go into anxiety, some into panic attacks because epigenetically there is a marker or a “tattoo” of trauma.

SK: It sounds like a replacement. If people are inheriting through epigenetics this feeling of distrust and this remembering of colonization, it sounds like you’re replacing that idea so that more and more generations can have a more positive, trusting outlook. Is this what’s happening? Are you seeing any changes?

TNB: It’s been amazing. Just in four decades, I’ve been with families where when the mom and dad sober up and they’re clean and sober for 20 or 25 years, you can see it in their children and their children making better decisions. We see a lot of young people who choose never to drink and never to use drugs. What you see is them go through the natural maturation process.

One of the indicators, even 20 or 25 years ago, we had very few PhDs or masters, now everywhere I go, everyone is getting their PhD and masters and they’re being creative. They’re going to art school. They’re going to become a lawyer or a doctor. In our community, we have a lot of registered nurses from our community college.

You can see, once you start to bring harmony with the parents and you do the deeper healing where there is forgiveness, because forgiveness is key. Forgiveness of what happened in the past and letting it go.

I saw this week grandchildren that were being raised in homes where the parents and the grandparents were present, and those kids are thriving. They thrive. They go on to be curious and they live long.

Suzanne Kryder Interviews Kermit Cole, marriage and family therapist

SK: Our program is about peacemaking and non-violent conflict resolution. We want to know what the conflict is around mental illness. It seems like it could be about personal conflict or in the healthcare community or in the culture. Where do you feel the conflict is?

KC: The conflict for me is in thinking that any of these things are independent of the other. The conflict arises from the impulse to immediately zero in on one notion of what a problem is and following that, one notion of how to respond to it.

SK: It sounds like what you’re saying is that it’s more about the relationship between people than it is a certain person.

KC: Well, what I want to say is that it’s about the relationship between the physical. The reason I say that is because I am not ruling out that the problem that we’re dealing with might be driven by any one of a number of physical problems from low blood sugar to an undiagnosed thorn in the foot to something wrong in the brain. The problem comes from starting with that last one, just going to that.

SK: It sounds like you have heard of this chasm between anti-psychiatry and pro-psychiatry. There are these two movements. Our program is about peace making. I’m not saying we’d get rid of this chasm, but what do you see as a resolution between these two movements?

KC: Well, as far as the mental health issue goes, it’s about reclaiming the distress that we experience as humans as a human problem. It’s not hard to understand that things that do or don’t go right in our relationships sometimes drive us to the brink of madness. The madness that we have all probably experienced at some time in a stressed relationship is actually really not very different than the madness that we ascribe to others under the label of a psychiatric disorder.

I can say this having see it, having seen people who were on the brink of psychosis as I’ve experienced myself in relationships or people who have been called “psychotic” who, once we resolved the relational issues and the history of relational traumas that they had experienced, weren’t anymore.

Some time in the last decades, a wall went up between things that we understood to be normal human stress and pain and something that we call psychosis. Anything on the other side of that wall we are ready to give over to psychiatry and psychiatry is ready to take it.

I’ve found myself having to fight for the right to work with people who were judged by others to be “psychotic.” I had to develop means to get that recast so that I had the right to work with these people.

We have a chasm now where as soon as somebody is called psychotic, they’re judged to be beyond the reach of normal human therapy, normal human relationships.

The experience of the open dialogue system in Finland for instance is that within that culture, people do not leap to that as quickly. They know that if somebody is thought to be psychotic then the response of the psychiatric system within that area of Finland is going to be to foster safe dialogue between the participants.

SK: What is Open Dialogue?

KC: Open Dialogue is the standard of care in the psychiatric system response to mental health crises in a particular area of Northern Finland after they had been at it for about ten years or so. They developed a cohesive system of response to mental health crises that they could call their own. They named it Open Dialogue.

Another way to understand what open dialogue is is that it’s based on a particular philosophy of what madness is, which is also based on a particular philosophy of what being human is, which is that to be human, to be a functional human being involves being in functional and fulfilling relationships and dialogue with others.

SK: Kermit, you’ve referred to people who are perceived as mentally ill as similar to whistle blowers because they might see something we don’t see, or they see it in a different way that we can’t see. Why is this important for peacemaking that we listen to people who see things differently?

KC: Well, maybe one way to think about that is that if we’re only listening to people that we already understand, then we’re going to be missing a lot of things.

Another element of being human is that, to the degree to which we’re able to weave in all the perspectives that are available, you’re going to have a much more elaborated, fully, multi-dimensional view of our world.

We’ll see into the past and into the future. We’ll see around corners. We’ll see over the horizon. But if the only perspectives that we’re able to integrate into our understanding of the world are the ones that we already understand, then ultimately, we’re in danger because something that will come at us at an angle that we are not ready for.

In terms of making a world of peace, the better we get at hearing and incorporating all the perspectives, even when they’re disturbing or frightening, the more peaceful it will be.

One of the stories I tell a lot is when I was talking to someone who was trying to tell me that aliens had given him the cure for cancer. We went around a lot about that. He was very eager that I could agree that this could have happened.

At one point I said, “I can’t say whether it happened or not. That’s not my expertise. What I’m interested in is what it would mean to you if it had happened. If you had the cure for cancer, what would that mean?” He just blurted out, “Then people would really like me.” That went right into my heart. I understood that.

I looked back at the huge moments in my life of things that I had done hoping someone would like me. Some worked out well, some worked out terribly, but for the most part, it worked out okay. Some of them were just as crazy. I was just lucky that I happened to zero in on some way for people to like me that worked. He was unlucky and picked aliens giving him the cure for cancer for whatever reason.

As soon as he said that, the whole tone changed, and the subject never came up again. We just talked about baseball.

The incentive is that as well as you can try to listen for what it might mean to a person if the thing they were saying were true or could be true. Often, you find that there is a really good reason to have tried to hear that. At the very least, it’s to try to understand the truth of that person, but sometimes it’s about something that they’re trying to tell you that’s really important.
It comes down to a choice. The problem with psychiatry for me is that it seems to offer solutions that seem to be certain and seem to make the promise of absolute safety and results. I don’t think that that’s actually true. I think if we’re thinking in terms of creating a world that is perfectly safe, anybody that’s telling you that they can give you that is lying. They’re trying to sell you something.

What I’m saying is that the world is an inherently unsafe enterprise. You have to choose whether you want to be in it, which involves taking risks and sometimes getting hurt.

I have taken risks with clients who I fully expected would be violent and were. I didn’t do it because I conned myself or anybody else into thinking that I had an answer that was going to prevent that. I did it because, as a matter of justice.

I’ve had every good thing in life that person could ask for and this other person hasn’t. Therefore, for me, it was justice to take the risk. That’s why you do it. You don’t do it because you think you’ve got a better answer than somebody else, you just say, “I choose the answer that I think is right because I think it’s right. If the dangers that I’m afraid of come to pass, then I choose that. I’d rather hope for the good things that I think can come from this choice than choose the bad outcomes that come from the other choice.”

Because of the system we have and some of the times those risks come to be realized as actual dangers to me that have cost me, at this point, half of the money that I made last year defending myself and trying to keep a license that I’m very proud to have in some ways, but it actually constrains me sometimes from being able to respond in a way that I would wish because the insurance company is driving our responses.

Basically, what that means is that we can only frame our response to a situation in terms of what is understood to be wrong within an individual and I have to give a diagnosis. It makes me sick often to have to do that because sometimes I can find a diagnosis that doesn’t have a traumatizing effect, but usually not. Usually it’s a diagnosis that I’d rather not have to give for any reason because the situation is about what’s going on between people.

The solution to the problem has to do with what’s going on between people, even if it’s a medical problem going on, the solutions that we find are in the relationships and strengthening relationships and helping people figure out how to navigate their future’s together.

Insurance is not set up for that. For that reason, for the simple fact that insurance is not set up in that way, it is a horrifically destructive influence in our lives.