Several months ago, I interviewed the late Sally Zinman, a heroine of our mental health movement of people with lived experience. I asked what changes she would like to see in the mental health system in the future. Without hesitation she said that the system should value and encourage self-determination and totally voluntary, noncoercive services.
I will discuss here the dangers of involuntary commitment, and demonstrate the ways that I believe (eCPR), which I will define below, contributes to Zinman's vision.
The Conceptualization of eCPR
I had gone to the limits of linear logic while working as a neurochemist in the National Institute of Mental Health. I agreed with my boss's reductionist theme that only the life processes we could describe by a chemical formula were real. My boss admired the degree to which I was able to get into the world of brain chemistry. However, after intensive psychoanalysis, radical therapy, and improvisational dance, I flipped into a more intuitive, feelings-based way of being. I became mute and was hospitalized on several occasions. I became convinced that words were of secondary value and that I could trust only people with whom I could communicate through nonverbal channels. Touch, facial expression, tone of voice, and hand gestures became more important than words.
Each time I retreated into that mute state, it was the other patients and the nonclinical staff whose caring helped me to return to consensual reality. All the time I was in those altered states, I kept thinking, "If only someone else had been where I am they would stop asking me questions, and know how to be with me." These breakdowns actually led to my breakthrough of realizing I could better express my hopes and dreams by being with people on an emotional level. I could be my authentic "self" and no longer needed to be a mute and hidden being. To better develop this process of becoming one's authentic self, I and a team of others with lived experience of being trapped in altered states developed eCPR.
By analogy to physical CPR, in which a lay person is taught to reactivate a person's physical heart, eCPR teaches the lay public how to reactivate a person's emotional heart. Our goal in eCPR is to teach people to connect with others at an emotional level, through Connection with their own feelings. By expressing our suppressed feelings/emotions in the presence of another person we are both able to experience emPowerment. Through the combination of emotional connection and emotional expression with another human heart we are both able to experience Revitalization.
I will try here to describe what I understand of the process of eCPR and its relationship to self-determination. It will then become evident why coercive or involuntary psychiatric treatment -- which has recently been and in a growing number of cities and states across the country -- interferes with a person's development of their self.
Toward Self-Determination
I believe we each carry inside us an authentic self, who speaks nonverbally to us and others in the language of feelings and emotions. We have experienced in eCPR that heart-to-heart connecting is a crucial first step in helping a person feel alive. We are proposing that when a person assisting shows deep loving compassion for the person in distress, the mute being of the person in distress leaps out at the sound or other expression of the Voice of the person providing assistance. This mute being has been hiding in a secreted shell from a history of traumas.
This calling forth of the mute being of the person in distress may explain the most startling finding in the practice of eCPR: we repeatedly see the importance of the person assisting allowing themselves to authentically experience and express their feelings in response to connecting with the person in distress. It seems the source of distress for people often is that they were frightened and locked themselves away from their authentic self, perhaps only showing their false self to themselves and the world. My observations are that the authentic presence of another person breaks that fear circuit. This may be what we observe in eCPR: when we are in the presence of another person who can "be with us, not do to or for us," we can be courageous, and experience our emotions without fear. Then we can, by the loving, accepting presence of another person whom we trust, experience our own feelings and emotions without fear. In doing so, we develop a deeper awareness of our deepest self and can be the person we were meant to be.
Research has shown that people with a lived experience of a mental health condition have the potential to develop an effective program and train people to deliver eCPR. In , researchers found statistically significant before and after changes related to one's ability to identify emotions, support others in distress, communicate nonverbally, share emotions, and take care of oneself, as well as changes to feelings of social connectedness, self-perceived flourishing, and positive affect. Furthermore, the study indicated encouraging evidence of improvements related to loneliness, empowerment, active-empathetic listening, mindfulness awareness, and hope (however, these were not statistically significant).
To return to Zinman's request, I would say that eCPR improves our capacity to become self-determined beings through the development of our authentic self. On the other hand, when people are coerced or confined, treatment is ineffective because of a lack of trust and ability to express one's authentic self. eCPR is a trauma-informed practice because it helps heal the three primary impacts of trauma. Trauma blocks peoples' emotions, leading to emotional isolation, disempowerment, and emotional numbing. eCPR helps heal these three dimensions of trauma through connection, empowerment, and revitalization of emotions.
By knowing our feelings through eCPR we will more readily make decisions that emerge from being in tune with our deepest passions. These are the types of decisions that are more enduring whether they concern relationships or work or any other aspects of life. This makes for lasting mental health improvement.
As Blaise Pascal , "The heart has its reasons which reason knows nothing of..."
Daniel Fisher, MD, PhD, is a psychiatrist, and the vice chairman of the board of directors for the National Coalition for Mental Health Recovery and Chair of the Board of the National Empowerment Center.