RECOVERING FROM RECOVERY

     About ten years ago I worked for a behavioral health company which at that time went by the curious name of MetaServices and which is nowadays calling itself Recovery Innovations. That word, "recovery," is a big one these days in the world of mental health, or, more precisely, in the world of mental illness. I was brought aboard MetaServices by a nice enough woman, one I shall refer to only as Lori. She was the executive director of what they were calling at that time the Recovery Education Center, something that they now speak of as the Recovery Opportunity Center. My job? I was to head up something called WELL, one of the cute acronyms so adored by those in Behavioral Illness. This acronym stood for Wellness and Empowerment in Life and Living. Over the next several months, I was to be tasked with forming a team of WELL facilitators, contacting case management sites, and bringing in revenue to allow the team to teach classes in recovering from mental illness.

    If that all sounds a tad vague, rest assured I knew less about the subject then than most people reading this do today. My background at that time was in corporate training. I had had a couple articles published in trade journals. All I knew about behavioral Illness was that there sure were a lot of crazy people in Phoenix. I did not realize, when I accepted the job with Meta, that I would be working with many of them. I also did not understand just how crazy some people can be.

    The WELL Program was intended to hold classes on site at each and every Value Options clinic in Maricopa County, Arizona. Value Options was the for-profit company that administered the money provided for behavioral illness services in Arizona, as well as several other states. These classes would be attended by people who were receiving psychiatric services at the case management sites. Those people had heretofore been referred to as SMI, or Seriously Mentally Ill. But times change, even in the loony bins of America, and there was a movement to begin referring to these folks as "Peers," a presumably less judgmental classification that implied a certain Three Musketeers aspect to things, in the sense of "One for all and all for one." What the use of this term actually did was annoy administrators and set up a false dichotomy between patients and the treatment teams. 

     My right hand woman, we'll call her Ellie, was herself in recovery from mental illness. I never asked her diagnosis, but she volunteered that she suffered from something called Borderline Personality Disorder. What I knew about BPD you could hold in a doll house thimble. Nor did I much care. To all appearances, Ellie was sharp as a whip, possessed no small amount of what passes these days for charisma, and knew the ins and outs of the mental illness system far better than I did. It would be to my detriment that I waited several months before investigating the nature of Ellie's illness.

    Most of the people then in upper management at Meta told me my young assistant was bad news. One said, "She will only be happy for short times and then only when she is stabbing you in the back." Another informed me that people such as Ellie "cannot even get help from therapists because the therapists won't deal with them because they get fed up with being manipulated by their patients." Even Lori, my boss, suggested I try to find some way to discharge Ellie. 

    Admittedly, I had noticed that Ellie was a person fairly described as uneasy to get along with. The same might have been true of Norman Bates. For instance, she would beg me to allow her to initiate certain special projects which, once she had my blessings, she would rush to begin and then promptly ignore. I was also aware that she made a habit of undermining my presumed authority with the rest of my staff. She showed indications of needing to be the center of attention. She loved to make speeches and she was good at it. In fact, she was good at most things she did there, such as recruiting patients or SMIs or peers to come to the classes. She was good at facilitating these classes. She was good at boosting the confidence of withdrawn people. So initially I view Ellie as a tremendous asset.

    Then one afternoon she admitted to me that because I was not a peer myself, there was no way she would ever trust me and that if it were in her power she would never let me anywhere near the clientele because I could not understand their problems. 

   I had to decide whether Ellie's oddness was the result of mental illness or simply a character flaw. If the former, I had no interest in adding to her sense of abandonment by dismissing her. If the latter, I had no reservations about throwing her out on her ass. 

    The National Education Alliance for Borderline Personality Disorder, quite sympatico with the peers, defines their members' illness this way: "Borderline personality disorder (BPD) is a serious psychiatric illness. The diagnosis encompasses patients with a pervasive pattern of affective instability, severe difficulties in interpersonal relationships, problems with behavioral or impulse control (including suicidal behaviors), and disrupted cognitive processes. This instability often disrupts family and work life, long-term planning, and the individual’s sense of self-identity. The estimated prevalence of BPD in the general adult population is about 2%, mostly affecting young women. It has also been estimated that 11% of outpatients and 20% of psychiatric inpatients presenting for treatment meet the criteria for the disorder."

    That was far too sympathetic to be of any use to me, so I looked to Psych Central. They had a much more interesting approach. "The main feature of borderline personality disorder (BPD)," they said, "is a pervasive pattern of instability in interpersonal relationships, self-image and emotions. People with borderline personality disorder are also usually very impulsive. This disorder occurs in most by early adulthood. The unstable pattern of interacting with others has persisted for years and is usually closely related to the person’s self-image and early social interactions. The pattern is present in a variety of settings (e.g., not just at work or home) and often is accompanied by a similar lability (fluctuating back and forth, sometimes in a quick manner) in a person’s emotions and feelings. Relationships and the person’s emotion may often be characterized as being shallow.
    "A person with this disorder will also often exhibit impulsive behaviors and have a majority of the following symptoms:

• Frantic efforts to avoid real or imagined abandonment
• A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
• Identity disturbance, such as a significant and persistent unstable self-image or sense of self
• Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
• Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
• Emotional instability due to significant reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
• Chronic feelings of emptiness
• Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
• Transient, stress-related paranoid thoughts or severe dissociative symptoms."

    I knew now that I was getting somewhere. 

    While I was still learning about this illness and there would continue to be many things about it which I never did learn, I knew one thing with total certainty: Ellie was making my life and those of many of her subordinates extremely unpleasant. There was a short line of people outside my office and one in my chair every day, sharing their latest Ellie encounters and vowing to quit if I didn't do something about her. Sometimes the problem was that she would interfere in their work, nitpicking them until they wanted to give up and let her do the job instead. Other times she was deceptively compassionate, even somewhat amorous, approaching males and females alike with sly innuendos that first flooded my employees with flattery and then strangled them with torment.

    The closest I ever came to a break-through was when the time came for completing Ellie's Performance Appraisal. There is a certain hierarchy implied, hell, mandated, by the Employee Review process. No matter whether the employee writes her own or if it is composed by the boss, or a combination of the two, the presumption is that one of these two people is in some way superior to the other. I knew that the implication of this hierarchical thinking would be resisted by Ellie, and wishing to avoid that and to actually have the Appraisal process be of some genuine value, perhaps even therapeutic, if you will, I told Ellie we would dispense with the typical procedure and instead conducted a Question and Answer dialog between the two of us, one through the medium of email, so that the physical presence of either person would be diminished and honesty could flow unimpeded.  

    You, reading this today, are undoubtedly more enlightened and perceptive than I was ten years ago. Trust me. You are. I can say this because I am willing to bet that you see the inherent flaw in what I proposed. I did not see it. 

    What resulted was that she mopped up the restroom floor with me. The Q & A became more about me and my management style than it was about Ellie and her choices/compulsions. "Why," she asked several times during the online discussion, "do you find it necessary to interpret my behavior in that way? Have you had some sort of earlier experience with someone that I remind you of?"

    As Bogart once said, "You're good, schweetheart. You're very, very good."

    After a year of this type of silliness,  decided to pack it in. Ellie was not the only reason for this, although she played a big and angry part. The other major reason I left Meta was because I misunderstood what the company was all about. I somehow got the impression that the goal was to give people hope and courage so that they could play active roles in their own recovery, utilizing peer support techniques, classroom training and other methods. What it turned out MetaServices was all about was getting funding from state and federal governments (and administered then through Value Options; these days through Magellan) to pay peer support specialists to stand in a room and tell people suffering from psychiatric symptoms that they should come to work for Meta where they could do the same thing, i.e., convince people in recovery to teach even  more people that they can recover. If this sounds like a sideways Ponzi scheme, well, that's good that it sounds like one because that is what it is. Sue me, Recovery Innovations. As FDR said to the bankers, I welcome your contempt.