Interviewed by Grant J Everett
Dr Daniel Fisher is a psychiatrist from the United States of America. Perhaps unusually for a psychiatrist, he is open about his lived experience of mental health issues. Many in his profession insist that you don’t recover from schizophrenia, but Dan says that recovery is real.
Dan spared some time from his international tour to speak with Panorama Magazine.
Dan’s “Emotional CPR” workshop aims to change the way we perceive distress, teach us how to be there for people who are struggling, and to use our lived experiences to steer the future of the mental health system.
“Emotional CPR is a peer-developed, peer-inspired introduction to mental health first aid,” Dan told Panorama.
“Mental health first aid appeared about 10 years ago, and while it sounded like a good idea to begin with, teaching the general public how to identify mental health issues might have actually increased stigma and discrimination” he says.
“Emotional CPR, on the other hand, has no mention of diagnosis or symptoms or mental illness or anything clinical, and it focusses on what we can do to help somebody who is in emotional distress.
“Just like how CPR is for cardiac problems, Emotional CPR is for anybody who is upset. Anybody can take part in this workshop, as we all instinctively have the ability to be with people who are in distress. When there are no professionals around, Emotional CPR can potentially make a real difference in helping people through their struggles.
“The main thing we teach about distress is this: don’t try to fix it, don’t try to explain it, don’t try to judge it; just be there for the person. By simply being with them, you will boost their ability to cope and to heal.
“This workshop is universal. It’s for people who have been labelled, as well as people who haven’t. Sometimes we call the second group “chronically normal.” After all, they seem to be well, and those of us who are labelled are meant to be unwell. In many cases, those who are labelled “unwell” are like the cultural canaries in the coalmine.
‘… they’re more issues of a broken heart than a broken brain. Unfortunately, the mental health system has neglected this extremely important dimension.’
-Dr Daniel Fisher
“I think we’re a little more sensitive or a little more vulnerable to the cultural ills around us. The lack of feeling, the lack of heart…I never thought I’d quote our current President – I’ll just call him number forty-five – but he said a fairly significant thing recently. He said, “I never would have imagined that running a government required a heart, because I come from the business world, and there it’s better not to have a heart.” So we have a heartless world, and some people can live without a heart. I don’t know how they do it. Are they the well ones? Are we the well ones?
“I’ll be going to Puerto Rico later in the year (they’re very keen on Emotional CPR there). I’ll also be visiting Scotland and Wales. So far we’ve run this course in Japan, Taiwan, Poland…Iceland is very big on it. Because we focus on the emotional dimension, that’s a commonality that crosses cultures. But some cultures are more comfortable with emotions than others.
“For instance, we usually do ‘practise scenarios’ where one person recalls something distressing in their life and the other person assists them through it. But in Japan the participants were particularly concerned about doing this in front of their friends and co-workers, so they repeatedly asked us to do the role-plays for them.”
Singaporean participants came up with a challenge that Dan had not anticipated.
“As they are a very orderly society, the Singaporeans wanted scripts,” says Dan. “We find that scripts don’t work very well because they’re not real, so we had to adapt. Another adaptation is for clinicians. They’re a different culture because they’re taught not to share their own emotions. But we tell them that it’s really helpful to share how you’re feeling when you are consoling somebody. Clinicians also prefer more slides and a lecture-type presentation style, while people with a lived experience (and their families, carers, friends and so on) tend to be more comfortable with a conversational approach.
“Something else I emphasise is relationship building, because I believe that the majority of what’s described as mental illness is a failure to connect on an emotional level with other people. This interferes with intimacy, love, romance and successful job performance, because in the long run all of our human endeavours depend on human connection,” says Dan.
After 20 years working in the field, Dan has come to the conclusion that recovery is possible for all of us, and he wants to spread the message that the true power of a lived experience is far beyond what the average person would assume.
“Quite a few participants have said the group was lifesaving. There was a woman in Singapore who spoke to us following the workshop. She told us that when she started the group she wasn’t sure if she wanted to go on living, but afterward she felt like she had purpose and meaning in her life.”
-Dr Daniel Fisher
“We’ve done many studies on people who have recovered, and whenever we asked them about the most important part of their recovery journey, it’s ALWAYS about relationships. But until Emotional CPR was developed we hadn’t really focussed on what relationship dimensions were most important. So a lot of treatment up until now has been on the verbal level. You know, questions, answers. Telling stories and narratives. They all tend to focus on the cognitive. But these issues, they’re more issues of a broken heart than a broken brain. Unfortunately, the mental health system has neglected this extremely important dimension. It sends the message that the primary role of a person who is being treated is to take their medication, rather than learning how to connect. I believe there is an over-reliance on the medical.”
Dan wanted to make it clear that he is not against medication. “Whenever I discuss the benefits of non-medical support, this has often been interpreted to mean that I am opposed to medication. I’m not,” he says. “I’m a psychiatrist, I’m board certified, and that means I prescribe medicine. But whenever I prescribe medication to somebody, I’ll tell them, “This won’t solve all your problems: YOU are the person who must solve your problems. You, deep down, are the healing agent.
“Recovery is real. I’ve been through it. I’ve seen it happen in others. So it’s strange how so many people still refuse to accept that recovery from severe psychiatric problems is real. In my case, they deny it by saying, “Well, you must have been misdiagnosed, because people don’t recover from schizophrenia.” I’ve had people listen to one of my talks and then come and tell me, “You made sense. You must never have had schizophrenia.” And I get very angry about that, because that’s like denying the possibility of recovery to millions of people.
“Recently, a Professor of Abnormal Psychiatry at Boston University was teaching a class, and he said that “people with schizophrenia don’t recover.” A friend of mine was in that class for a Master’s level course, and she raised her hand and said, ‘Actually, friend of mine recovered from schizophrenia.’ The Professor dismissed this by saying, ‘Then he must have been misdiagnosed.’
“So she called me up,” says Dan, “and I told her ‘I’m so tired of this. Let’s put this to rest right now. Let’s go through the DSM IV (this was a few years before the DSM V).’ So we went through the criteria for schizophrenia, which haven’t changed that much.
“Yes, I had the television talk to me. Yes, I isolated (I didn’t talk for a month at one point). Yes, I had some pretty striking positive and negative symptoms. I felt very discouraged and very unhappy. I wasn’t sure I wanted to go on living, and so on. As I definitely met the criteria, she took these findings back to her Professor. His answer was, ‘Oh, then we have a case of disabled psychiatrist.’ In his mind, since I met the criteria of schizophrenia, I must still have it, because he believed that people never recover. So obviously, I’m a disabled psychiatrist.
“It still makes me mad when I think about it! It’s beyond frustrating! It’s infuriating.
“One of the things I teach in the Finding Our Voice workshop – something that I have to keep teaching myself – is to hold onto that anger, that righteous anger, and transform it into passion. I think of Mahatma Gandhi: he freed 600 million people, but it took him and his compatriots decades. Gandhi was always very patient and thoughtful, and even getting beat up wouldn’t discourage him. He said, “I take my anger, I compress it, and it becomes the energy for my force, my change.” I try to remember that.
“I also try to remember Nelson Mandela, and Martin Luther King Jr. Martin Luther King Jr. said, “Although we have many setbacks, the arc of history moves towards social justice.” It seems hard to believe that at times, but that gives me hope.”
In addition to being the Executive Director of the National Empowerment Centre, a professor of psychiatry at UMS Medical Centre.
Dr Daniel Fisher’s book, Heartbeats Of Hope, is available from Amazon, or the National Empowerment Centre website.