Thursday, February 3, 2011

Crash Course in Care - Step 2: Being an Advocate

Salutations, New Mad Nation.

First of all, a heartfelt thanks to Sara Hendrickson of for our stellar new header design. She is a tremendous supporter of our work and I encourage anyone who needs anything designed, from business cards to personal logos, websites, or just about anything else, to contract her. She's fresh out of college and needs the work!

That said, it's time to get down to business. The long-awaited Crash Course in Care Step 2 is here at last. There are many other things on my mind tonight, but I sense they are just going to have to percolate a while longer before I can do anything useful with them, and the crash course must keep crashing. The title for step two is "Being an Advocate." This is because, in order to take care of someone, we must realize that we are doing more than treating a series of symptoms, but actively working to protect our friend or loved one from harmful influences. Just as one works to create a sanitary environment for someone healing from a serious illness, one must work to create a friendly and supportive environment for someone struggling with their mental or emotional health.
You may note, here, that I have made a direct and deliberate comparison between physical illness and mental/emotional distress (sometimes called "mental illness"), but I must stipulate that I have only done so because in this analogy, the contagion for mental/emotional distress is social factors, factors that you, as a care-giver, must protect your friend from. Thus, you must be an advocate.

How does this look in the context of giving someone care?

Well, let's say you are sitting at home, "chilling" (or not) on Facebook, when your friend IMs you and wants to know if they can come over for a while. You say sure; alright, they come over, and suddenly they are way more upset than you are used to. You can tell that there's a dangerous situation developing here. First things first: remember step 1. Check your privilege at the door. Remember, first and foremost, that them even being here, allowing themselves to be upset in your presence, puts you at a huge privilege advantage - they are making themselves vulnerable, and it is up to you to decide how to handle the situation. As you go through the list of other privileges you may have over this person, make sure your decision is step #2 - Be An Advocate.

Listen to your friend's situation, giving them their whole truth. Question it only if it seems necessary to avoid serious conflict, and even then, do so gently; or perhaps if the upset is based on incorrect factual information. For example, "I don't know what to do because I think the prof hates me," when you have heard the prof praise that student; you can share this information, but do so without directly contradicting them - say "Well, I guess I can't be sure, but I heard the prof say that you were actually a really good student." This opens up the possibility for conversation where you are on their side, helping them to figure out what's going on, rather than telling them.

Advocacy really comes in as you reach the end of the story, trying to figure out where to go next with your friend in their road to handling their distress. Much of it will be personal, and will require you to offer them opinions that they may process in their own time at their own rate, and may conclude - correctly - to be invalid. As an advocate you must be prepared to work for your friend. They are the boss of their own mental health. So, for instance, if your friend feels persecuted by someone else, someone you don't think is persecuting them, you may offer that opinion, but do so very gently, and with full and stated recognition that you may be wrong. Add on to this that you are willing to work through the situation with your friend to find out what is going on and/or how to handle it.

Many proponents of more traditional therapies and "mental illness" models would look at a situation like this and try to interrupt the "patient"s cognitive cycle, because they start with the assumption that the person feels persecuted because they are depressed, rarely acknowledging the possibility that it goes the other way around. But even when a person or institution does acknowledge that depression may be stemming from feelings of persecution, the response to this is often in the form of suggestions for how to cope with being persecuted internally, while not actually stopping the persecution. I view this as an inherently flawed approach; it is like giving medicine to a sick person who is still exposed to the infectious disease. (Again, medical analogy, but only because the contagion is social factors.) Don't get me wrong: developing the internal faculties to be more resilient to persecution is incredibly important and absolutely worth pursuing - but not at the cost of complacency towards being persecuted.

That's where you, The Advocate, come in. It's not enough to say "Hey, I don't think they meant to hurt you, try not to take it personally. I think they just were making a joke, you know?" It's probably not enough, in most cases, to even say "Man, those people are totally jacks, you shouldn't listen to a thing they say. They don't know what they're talking about." You have to acknowledge that someone has hurt your friend, if indeed they have - whether they meant to or not - and then, where it makes sense, challenge that hurtful behavior. As an advocate, you should be challenging behavior patterns that make it possible for people to say hurtful things, even if they aren't meant to be hurtful.

Many hurtful things are said out of ignorance, for example. We see this kind of advocacy being championed for all kinds of causes, especially women's rights, anti-racism, and GLBTQ activism. We are taught that to be an advocate is to actively fight the kind of atmosphere that allows hurtful behavior to go on; things like ignorance and callousness are to be fought. It's not enough to say to someone who feels ostracized because of their gender, race, or whatever else, that "Hey, they don't really mean it, try not to let it get to you." You have to be willing to stand up to the people in question and expect them to change.

Why do I bring up these other categories of advocacy? Because mental health conditions such as depression or anxiety can very easily result from issues like these, and so they are inherently linked. However, there are unique categories of advocacy for the condition of depression (and other unique distress patterns) itself. There is stigma and misunderstanding towards behavior patterns associated with depression, and hurtful behaviors can result from that. As if it isn't hard enough to be struggling with depressive seeds (for whatever reason), social factors can make this infinitely worse by lampooning the feeling and behaviors of depression itself.

Be willing to make a stand for your friend or loved one, ESPECIALLY if it means challenging your own friends. If your own friends seem responsible for hurting the person you are trying to care for, then you will seem responsible by association if you do not challenge them.

On a deeper level, it is important to recognize the possibility that your "friends" may actually be doing hurtful things with a bit more venom than you would like to believe. This can be very difficult and isn't always necessary but it is important to consider the possibility. Many people have prejudices towards others - ever hear the word "emo" being used negatively? - for their emotional state of being, prejudices that may be kept hidden pretty well, but exist nonetheless. The same is true for racism, for example. Always leave room for a little bit of doubt.

The general rule of thumb here is that after you leave your privilege behind, you be willing to take on a share of your friend or loved one's problems as if they were your own. You can coach your friend on resilience if you have any genuine insight, but also try to view their concerns as really as you can.

Most importantly, always, always, ALWAYS, is this: listen to the person you are caring for, talk with them as an equal, and work with them to figure out what you can do to help. They may not need a fighter, yet, or ever; they may need one right that second. Maybe they need someone to give them a nudge, maybe they need someone to let them just be. Find out by working with them. This may also mean that sometimes, even though they seem to need your help, you will have to leave them alone. Try to intervene if you sense something unbelievably horrible about to happen, but otherwise, it is usually best to give people their space.

Allow me to provide a counter-example of how NOT to be an advocate.

If a friend has come to you for some kind of solace or advice because they have been thinking about self-injury, do NOT try to make them promise not to do it. This may seem like you are advocating for them, but all you are doing is contradicting and denying them their truth. You can ask them not to if the knowledge of it causes you pain, but you must respect and understand their pain as well, and be willing to let them hurt themselves if they need to. This is incredibly hard, but you can't really be an advocate if you try to force a person not to do something. That removes their agency and is belittling.

To be perfectly clear, I do NOT encourage self-injury. To whit, I find cutting, burning, smoking, most drinking, most drug use, and anything else that causes harm to the body or mind to all be fairly bad ideas, whatever your reasons. However, I also understand that sometimes it cannot be avoided, and attempting to extract a promise to the contrary is basically forcing someone to add lies or total defeat to a situation that is already painful enough. Encourage a person not to hurt themselves, but don't take the hard-line of "I want you to promise me" or "I'm not leaving until" or anything like that.
Unless, of course, the person in question has previously expressed to you some sentiment that leads you to believe this approach would help them. For example, a person might have violent urges for self-destruction that they are very afraid of, and may have asked you or tried to ask you to help keep them safe from this. In this case, you advocate for the person by helping them fight their compulsion by being with them or doing whatever else you have to in order to protect them.

The common theme here is working with  your friend or loved on. Advocacy happens when you work with and for the person in question. Obstinancy and oppression happens when you work for your own comfort and what you perceive to be important for the other person.

The ONLY exception to the above is when your friend is planning to commit suicide. Even though I myself am of the opinion that people should be allowed to make the decision to end their own lives after careful deliberation and a reasoned conclusion that there is no worthwhile or possible way to improve their situation, I believe that it is very rare for a person to attempt suicide having actually gone through all of these considerations. Moreover, if the attempt should fail, the person will be put in a hospital where they will more than likely be traumatized even further by the staff. (If this sounds hard to believe, wait until I post a full rant on the subject of the hospital locked ward.) Therefore, if a friend is planning to commit suicide, then and only then would I say you have the right, as their advocate, to try to talk or otherwise force them out of it - BUT DO NOT CALL THE POLICE UNLESS ABSOLUTELY NECESSARY. As I said, going to the hospital can be unbelievably traumatizing and you should try everything you can to intervene on your own before your resort to this.

Well....I suppose that's about it for today. The specific examples of how and in what ways one can advocate for their friend are largely circumstantial. Perhaps some day I will post a few full-length tellings of the process of giving care, through the various steps. For now, the take away message is that you should always let your friend have control over the care-giving process, and always be willing to take their problems on as your own - put their needs before your own when possible.

Just make sure you can still take enough care of yourself to actually be able to care for them.

All thoughts welcome, just remember the rules. Thanks as always for your attention, everyone.

To the New Mad Nation, I bid my fondest salutations.



  1. You always have such sound and well-thought out advice. Bravo!
    I feel like everything you've posted, especially this one, goes against what society traditionally thinks about "helping" someone/people's mental health, but does so in such a convincing and gentle manner, this could easily be put into a book. But a blog will do for now. :)

  2. Awww, you flatter me extensively, my friend. A book does sound good, doesn't it? Thanks for reading/commenting. This keeps me going. :)