A note on knowing things
Or, practical epistemology for solving socio-systemic problems
There are people with lots of different kinds of training and experience getting involved in the Psych Crisis project. Some people will have gotten a medical degree; some people will have had an experience of psychosis; some people will have built organisations like tech companies or nonprofits, and more.
A person’s purpose–what they care about, in each of these contexts, is quite different. A medical student cares not only about learning as best they can how to help patients, but also about graduating successfully and getting a good job. A person experiencing psychosis cares about surviving it, and perhaps also about retaining the respect of other people who may judge them harshly for what they’re going through. A business leader cares about satisfying customers, employees, and investors, and perhaps keeping their job.
In the Psych Crisis project what we care about is people recovering well from mental health crises, and feeling like they are being treated well–compassionately, and with respect and kindness. We also care about being able to help a lot of people who are in crisis experience that–so we care about growing, using money wisely, adapting to different crisis situations, and being reliable. As the project’s founder, I care about doing work that requires me to become more capable and kind, doing something important, and nourishing my motivation to keep going. As this project employs people and partners with funders, it will necessarily care about satisfying them too.
Keep these goals in mind as you read the following section.
Each of these backgrounds I mentioned above has a culture around what it means to know something, and who can be trusted to know certain things. These ‘cultures of knowing’ help simplify life for any individual with that background, who relies on knowing things the way people in that context know things, rather than encountering every new piece of information from scratch. These ways of knowing have generally built up over a long time, with the contributions of many people from that background, from that context.
The downside is that people get so used to these ways of knowing that they see them as ‘the way things are’ rather than ‘the strategies we use for making sense of things’.
Scientists and people with a lot of respect for science might only trust a treatment method that is ‘evidence-based’, but ignore methods that might work just as well but have not had champions who have pushed the treatment methods through the demanding and expensive scientific research process, or ignore problems with the quality of the research for popular treatments.
Members of the peer advocacy movement might distrust professionals that claim to be ‘objective’ but wield a lot of control over their patients, and only trust services that are run by ‘peers’--those who have been on their side of the situation. They might then ignore situations where people labelled as peers act in a controlling or alienating way to those they serve, or situations where people with professional roles protect the autonomy and dignity of their clients, or relate based on their own experience having had a mental health crisis.
Someone who uses symbolism and art to help people might distrust someone who uses medications to help, and vice versa. Someone who earned an expensive, difficult degree might distrust someone without one. Someone who has very little power in medical or bureaucratic places may distrust someone with more.
In general, it’s common to find people who are involved in the mental health field who see all mental health problems through a single worldview, with a single kind of explanation, and distrust anyone who does not share their worldview.
One good reason for this is that most of us have not yet learned how to explore and make sense of new things that don’t fit into the worldview we have–the worldview that helps us make sense of things safely and usefully.
It’s as if we have a scale to measure objects, and then we encounter a weightless gas–we don’t know what to do with it!
The Psych Crisis project involves people from lots of different backgrounds, each with their own ways of knowing and rules of thumb to help figure out what to do.
I plan to figure out with many people (including some of you reading this!), over time, a way of seeing that can look from all those perspectives at once. I want to do this not only because I think it is a good way to treat people, but also because it’s the process that I think will work! It seems to me that current approaches to crisis care fail in the places where they ignore some important part of the process, and it seems that they often ignore it because it doesn’t make sense within the common worldview within which the approach was built.
A financial projection cannot help you make sense of the deep anguish of a person at the brink of suicide, but the heartfelt story of that person’s experience cannot help you figure out what money needs to be spent where in order to make sure that when someone calls for help, help arrives.
A research-backed explanation of how a drug triggers a psychotic state can tell you what to expect once weed triggers someone’s psychotic episode, but it cannot give that person the courage to endure the things they fear without the support of weed. And a longtime friend may be able to give the encouragement needed, but lack the time, the mental models, and the experience of having seen lots of people experience similar things to be able to predict what will happen once the person stops smoking.
For each of our ways of knowing, as we get more familiar with it we learn what it’s like to be good at it–to be a good artist, a good doctor, a good activist, a good friend, a good therapist. To be a good something means to be able to understand the world in a way that is powerful–that lets you know what will happen in the future, or connect with someone in challenging situations, or take actions based on what you know to get what you want.
We want to know if someone is a good something because we want to know whether or how to trust them. We trust that a good peer advocate has integrity and will not take advantage of the people they’re in relationship with. We might trust that a good doctor listens for accurate information about our situation and doesn’t make mistakes when prescribing medications. We might trust that a good therapist will not foist their opinions on their client.
If your background is in scientific research, you may have the ability to discern whether there have been a large enough number of rigorous-enough studies done on a treatment to trust it. But you may not yet be able to discern whether, for example, a client is calm or dangerously dissociated, the way someone who works in a crisis centre might, even if they couldn’t articulate it to you in words.
You likely already have at least one worldview (perhaps a few) with a set of explanations about how to create a project to create a better kind of mental health crisis system. Having a coherent set of explanations about how the world works is a powerful thing. This is helpful! And yet, this project requires learning to do some other things that may be new to you.
You might:
Get better and better at the ways of knowing within the worldview/s you already have,
Learn how to make sense of things and people that don’t fit well into your normal ways of knowing
Find the limits of what that worldview is good for; what it cannot do. These are the limits where we explore different worldviews, or develop trust in people with more suitable worldviews. Ideally, both.
You probably already know something about how to get good at the ways of knowing you have. Within your field there might be training, or reading, or practice, or apprenticeship–the specifics will be different in each field.
Learning to make sense of things that don’t make sense in your worldview, and finding your worldview’s limits–these are processes that take a while (they have taken me a while, and I think I’m now pretty good at it compared to most people). I plan to write about this in more detail, but in the meantime, you can ask me directly.
These are some important things to know about how I understand knowing things, within the context of working to make a better system of crisis care. I suspect Psych Crisis will involve more reflection on how we know something and how to improve the ways in which we make sense of things than most projects do, as a necessary part of making something that has a new culture along with a new system.
I’d like to know what your experience of reading this was like, if any parts were difficult to read, or you liked or didn’t like aspects of it. I’d like to make it easier to understand, easier to find points of disagreement with, and relevant to people from a wider variety of backgrounds.
Some questions for you:
What background do you come from?
(You might come from two or more, in which case you have a head start on relating to different worldviews compared to the rest of us!)
In that world, how do you know if a ‘mental health treatment’ is good? (sub in different words if that doesn’t work for you)
E.g. it has been validated in peer-reviewed experiments
It respects a person’s autonomy and choice
In that world, who is the most respected person?
(If you can, answer based on what you have observed, not based on what people say is true!)
If you come from two or more worlds, repeat this process for each background you have. I.e. if you are a scientist and an artist, or a person with lived experience and a clinical degree.
Who are some specific people or sources you trust the most?