nursingforsocialjustice

I attended an virtual conference on concurrent disorder today. Maybe you attended it too. Over my career I have attended many a conference. I have even presented something at some of them. The first concurrent disorder focused conference I attended was the David Berman conference in 2009. As you can see (if you click on the link) it was the 17th one. 12 years later, I was a bit puzzled as to why the conference I attended today was framed as being a starting point for a sea-change on concurrent disorder care. Some offer the position that perhaps a re-envisioning of what we call concurrent disorder is necessary knowing all we know today.

Curiously, harm reduction was not something included in the presentations today, nor systemic racism, nor decriminalization, nor the mental health act and impact of coercion in care. The following are my reflections of the day.

We still perpetuate myths like “This Is Your Brain on Drugs,” even in systems that make efforts to decrease stigma. There’s all sorts of psychotropic drugs. There’s all sorts of street drugs that are also very similar to pharmaceuticals. There are drugs purchased illegally that are exactly the same as prescription drugs. The line we draw, between those illegal drugs melt your brain and cause irreversible damage, and the ones that make you a better person is, in some ways, (many ways?) arbitrary. Drugs are one thing. The context of someone’s life, and the experiences that they have that lead to certain actions, certain choices, well that’s what we should really be trying to understand, no?

We don’t often (even in health services that are specialized to provide services to people who use drugs) ask about what people like about the drugs they use. It’s not a standard component of a comprehensive intake assessment…because it was already decided that they ruin lives and any good must be far outweighed by the bad. Until we collectively embrace that it’s not drugs in themselves they cause harm, but the way that collectively we have accepted that we look at people who use drugs then we are going to have a tough go at changing anything.

We really have to ask ourselves some questions like: does cocaine cause brain damage? What about crack? What about heroin? What about morphine? What about MDMA? What about cannabis? What about if it improves the quality of my life? What about antidepressants? Is this different when I’m using them in the context of therapy? Is it different if I have a stable job? What about if I earn a lower income? How about if I am a celebrity? Is this different if I am 20? I am 50? If you replace this with the word wine?

Our intentions can be the best but they don’t matter if we keep looking at the person as the problem and don’t work twice as hard at trying to change the society that’s perpetuating the injustice.

I wonder (more and more frequently) about the ethics of approaching helping people as an experiment. And that, I think, is the value of research methods that are not embedded in attempts at objectivity, single truths, and terms like “evidence-based practice” used as inherently something good without exploring what that means, where the evidence is from, who collected it, and how is it being used.

It is interesting to me that at a point I was a novice nurse, and new to healthcare. I arrived to nursing in Vancouver in 2008, when concepts like concurrent disorder were still relatively new in terms of peer reviewed research, conceptual clarity, knowledge translation, program development, education for clinicians. 13 years has gone by. I have grown as a clinician, a nurse, a thinker, a researcher. And now that I have changed, it is the system that seems stuck, still trying to diffuse what was considered innovation a decade ago, re-branding and re-packaging ideas and presenting them to today’s novices and newbies as if they are new. At this point my perspective is that this is where nursing crashes in like a bull in a teacup shop, breaking all those silly teacups and making room for something fresh that people actually need.

What if kindness was an intervention? What if asking someone how they are doing and listening wholly to the response was an intervention? What if eating with patients instead of watching them eat was an intervention? What if letting patients write stuff in their charts was an intervention? What if the line between clinician and community member wasn’t definitive at all? What if we acknowledged that we all need hugs, even people who have lived in an inpatient setting for 5 years (they probably need hugs more than anyone). These are not new ideas. My plan for 2021 is to get super deep into the theory of Peplau, Parse and Roach. I invite you to come along this journey with me.

Love,

Michelle D.

P.S. Things can be framed in a certain way, but that does not mean that the history is null and void. I also sometimes wonder about the use of ambiguous terms like “state of the art”.

P.P.S. If you haven’t read Stigma by Erving Goffman then now is a good time to read it. I’m pretty sure it should be required reading for nursing students.