Strategies and Issues For Developing “Mad Maps” Into a Clinical Anti-Oppressive Tool

I wrote this paper for social work school in the Fall of 2014. It was an attempt to synthesize a lot of information and use it in the service of our emerging Mad Maps work.   This is not an official Icarus Project document, it’s my own attempts to make sense of what I’ve been learning and weave it into our outreach work. This is the kind of writing that has no conclusions, just lets of doors to keep opening, ideas to share, bridges to keep building.

Strategies and Issues For Developing “Mad Maps” Into a Clinical Anti-Oppressive Tool
Sascha A. DuBrul
Clinical Practice Lab I
Hunter College Silberman School of Social Work

Abstract: In this paper I will use a number of sources from our Clinical Practice Lab syllabus to intellectually scaffold the importance of the Mad Maps program, an emerging clinical tool in development at my workplace, The Icarus Project. Using a synthesis of theories and concepts from social work including Mindfulness, Popular Education, and Critical Race Theory, I will provide a context for our work and show how the existing literature can guide the process we are attempting to unfold in our community based organization. While Mad Maps originated in a more traditional peer-based community organizing (CO) context, from the beginning at has had overlaps with clinical practice methodologies, and I will discuss the inevitable tension and potential productivity between the two. I will also discuss the tension and important distinction between oppression and suffering which needs to be articulated and reconciled in the development of Mad Maps. I will conclude with a concrete proposal to both officially align our work with the structure of Participatory Action Research (PAR) (Smith, 2009) and to develop Mad Maps into a tool that can be used in a supervised clinical setting in New York City in 2015.
Introduction – The Organizational Context

The Icarus Project is a support network and media project by and for people who experience the world in ways that are often diagnosed as mental illness (The Icarus Project, 2014).We are an international grassroots organization who encourage self-determination and harm reduction in treatment decisions and allow ourselves the freedom to explore alternative routes for personal transformation and collective liberation. I am one of the founders and have been working on the project for more than twelve years. In our recently revised mission and vision statement, we articulate some of our goals and aims:

“[The Icarus Project] advance[s] social justice by fostering mutual aid practices that reconnect healing and collective liberation. We transform ourselves through transforming the world around us….We envision a new culture that allows the space and freedom for exploring different states of being, and recognizes that breakdown can be the entrance to breakthrough. We aim to create a language that is so vast and rich that it expresses the infinite diversity of human experiences. We demand more options in understanding and navigating emotional distress and we want everyone to have access to these options, regardless of status, ability, or identity.” (The Icarus Project, 2014)

Mad Maps
The Mad Maps project was initially developed out of online forums almost a decade ago. Fueled by hope and creativity, our online forums became a platform for people all over the world to share individual growth and personal wellness strategies. By sharing our stories with each other, we built a radical mental health community that paved new roads away from the mainstream mental health model and we designed new pathways for self-growth.
Mad Maps are written and illustrated documents that we create for ourselves as reminders of our goals, what is important to us, our personal signs of struggle and our strategies for self-determined well-being. Though originally inspired by the idea of Advanced Directives (legal documents to share with doctors and friends in the event of being hospitalized), over time this idea has evolved further to include a transformative element: how do we move beyond adapting and coping, toward actually changing the world that we live in? By creating documents that help us to explore our mad gifts and better understand and get through tough times, we are able to re-envision the boundaries of our individual and collective potential.
The goals of the Mad Maps project are to both create a written and online guide that will greatly expand the language that is used to talk about health and wellness, and develop a clinically supported model which can be used in groups and with individuals. A key component of both these goals is the emphasis on social and political context: personal health and collective liberation.

In the following section of this paper I will describe some of the tools, strategies, and methodologies I have be exposed to in Clinical Practice Lab which I believe will be useful for implementing the Mad Maps project:

Mindfulness (Epstein, 2003)(Wong, 2012)(Burghardt, 2013)

According to the seminal article by Epstein (2003) on Mindfulness in Clinical Practice: “Mindful practitioners use a variety of means to enhance their ability to engage in moment-to-moment self-monitoring, bring to consciousness their tacit personal knowledge and deeply held values, use peripheral vision and subsidiary awareness to become aware of new information and perspectives, and adopt curiosity in both ordinary and novel situations.” (Epstein, 2003).
The goals of mindful practice are to become more aware of one’s own mental processes, listen more attentively, become flexible, and recognize bias and judgments, and thereby act with principles and compassion. As a practitioner of yoga and a student of somatics, one of the key lessons I have learned in my time of study has been the importance of developing intentional practices in order to transform the way I show up in the world. To make sustainable shifts in my behavior and ways of thinking, I have to “embody” new behaviors. The path to achieving that embodiment is established through a series of recurrent practices of mind, emotions, language and body. This new embodiment is integrated by building new interpretations of meaning and future possibilities. Embodiment allows for new action.
Epstein states: “Although mindfulness is a practice that derives from a philosophical-religious tradition,the underlying philosophy is fundamentally pragmatic and is based on the interdependence of action, cognition, memory, and emotion. These connections represent a relatively new idea in neuroscience research.Western approaches to the understanding of mental processes have historically separated mental activity from action in the world, and the schism between behavioral and psychodynamic psychology has reinforced some of this separation. However, in the East and in phenomenological traditions in the West,philosophy has linked cognition to emotion, memory, and action in the world” (2003).
It is this understanding of mindful practice that we want to bring into the program of Mad Maps. bell hooks speaks of education as “the practice of freedom” (hooks, 2014). Yuk-Lin Renita Wong (2004) suggests that critical social work has the potential to be this “practice of freedom”: to “transgress” the mind/body duality and create a wholeness and groundedness in our work.
Popular Education
Pablo Freire’s popular education method, experimental and participatory learning model and coalition building through group projects (Freire, 1970) has had a huge influence on the vision of Mad Maps. In 1970, Freire published his groundbreaking work, The Pedagogy of the Oppressed, in which he argued that people’s freedom from oppression requires an ongoing process of reflection on their socio-historical context, an analysis that leads to “a critical comprehension of reality” (p.47). This critical comprehension is facilitated by an egalitarian environment in which all are involved in dialog and sharing. However, “a mere perception of this reality,” according to Freire “will not lead to transformation” (p.37); rather, action must flow from this new critical consciousness. This process itself then becomes the subject of reflection, leading to a continuous loop of action and reflection. Underlying most of these methods is the belief that reflection in the mind will lead to action for change.
Critical Race Theory (as opposed to Cultural Competence)
We are grounding Mad Maps in anti-oppression theory, and Critical Race Theory which I was introduced to in the syllabus, has some important language to make use of in our work. In contrast to a “cultural sensitivity” model, Critical Race Theory (CRT) targets change at the level of a personal beliefs and agency practices, the “anti oppression model” works towards change across the individual, agency, and system levels (Abrams, 2009). In short: the cultural competence framework doesn’t address systemic and institutionalized oppressions. Critical Race Theory emerged in the wake of the civil rights movement and challenges liberalist claims of objectivity, neutrality, and color blindness. CRT argues that these principles actually normalize and perpetuate racism by ignoring the structural inequalities that permeate social institutions. P.250
Liberatory Psychology and Psychopolitical Validity
Martin Baro, who was murdered by right-wing paramilitary forces in El Salvador in the 1980s, inspired the development of liberation psychology in Latin America and community psychology throughout the world. (Martín-Baró, 1994) Martin Baro wrote of a liberatory psychology, one that involved “breaking the chains of person oppression as much as the chains of social oppression.
Psychopolitical validity was a term coined by Isaac Prilleltensky in 2003 as a way to evaluate Community Psychology research and interventions and the extent to which they engage with power dynamics, structural levels of analysis, and promotion of social justice. The evaluative series of criteria developed by Prilleltensky may be used within any critical social science research and practice model, but can specifically be defined within Community Psychology research as advocating for a focus on well-being, oppression, and liberation across collective, relational, and personal domains in both research and practice. While I haven’t studied the details, these theories seem very useful for our work with Mad Maps.
Racism as Pathogen
The concept of “oppression as pathogen” is incredibly relevant for the kind of narratives we are hoping to create with our work. Here is Laura Smith using racism as an example:
“Racism, still pervasive in US society and culture, has been associated with poor mental health outcomes in association with such variables as self-esteem, perceived control, depression, and generalized anxiety disorder (Williams, Neighbors, & Jackson, 2003) In addition, experiences of racial discrimination have been correlated with an increased level of stress response, including anger, frustration, paranoia, and fear, and somatic symptoms like headaches and backaches (Clar et al, 1999) Based on this evidence, researches have begun to refer to racist incident-based trauma, positing that racist incidents have traumatic consequences similar to those of rape or domestic violence (Bryant-Davis & Ocampo, 2005).” (Smith, 2005)
Internalized oppression and colonialism
Internalized oppression, which is understood to have its origin in experiences of powerlessness or social degradation, is the condition in which individuals who belong to oppressed groups believe themselves to be inferior to those in the dominant culture (Moane, 2003).
Fanon (1965) argued that by systematically denigrating the humanity of colonized persons, colonialism leads to a deep seated self doubt, feelings of inferiority, and identity confusion among the colonized or oppressed. Similarly, Memmi (1965) stated that oppressed individuals may ultimately internalize an identity consistent with the stereotypes of them sustained by those in power. Freire (1970) suggested that this identity can develop into a desire to distance oneself from one’s own group and aspire to become evermore like the oppressor.
Intergenerational Trauma
“Against the backdrop of US historical trauma (including the genocide and displacement of indigenous groups, slavery, Jim Crow segregation, and the internment of Japanese Americans), the colonial model, with internalized oppression as a corollary, serves as an integrative framework for the toll that intergenerational oppression has taken on the mental health of those who have been oppressed.” (Smith, 2009)
While we have many exciting ideas, the work of creating Mad Maps is still in the initial stages and therefore I would like to articulate some of the issues that have come up in the design of the project.
The Context of Intersectional Oppression

 

Madness and Oppression: “The Icarus Project’s analysis is grounded in awareness of the oppressive forces that shape our world and ourselves as we struggle to survive and even thrive. We believe that mental health does not exist in a socio-political vacuum. In [the Mad Maps project] we will reflect on the role that race, gender, class, ability, sexuality, the economic system and institutional violence may play in our experiences of madness. How do we move beyond adapting and coping, toward actually changing the world that we live in? How do we do this together, despite all our wounds? How do we find unity across causes? How do we grapple with the imprints of histories of oppression that stretch back through time, from before we were even born, but still affect us today? These are the kinds of questions we are hoping to explore.”

The Madness from Generations Past: “As discoveries from the new scientific field of epigenetics emerge, we learn that the experiences of our ancestors are passed through the next generation, affecting the way we deal with stress and anxiety, among other things. Mapping the life of our generations past will help us understand ourselves better, as well as be mindful of the inheritance we leave for the generation to come. Have your parents, grandparents or other direct ancestors of yours experienced trauma? In what ways do you think this might have affected you? How can we stop the transmission of this trauma to the next generation?”

Our Personal Maps: “Understanding ourselves, our gifts, our landscapes and how to navigate them. Coping with challenges, crisis and triggers. Reaching our goals for social and emotional wellness. Where are we and where do we want to go? How can we get there? What are our triggers? How do we cope with them so that we don’t get lost? What are warning signs that we have lost our way? How do we return home if we do get lost? How can our friends and allies help us? What has been helpful in the past and what has not been helpful? What meds have worked, which haven’t and how can we come off if we don’t need them anymore? How can we build the life we want to live?

Mapping paths to the community and the world we want to live in. If we had a blank canvas, what map would we create? What does the world we want look like? How can we take steps into making it possible? How can we work with each other toward overcoming our struggles and making our communities safer and healthier for everybody?”

Issues That Have Arisen (or Might Arise) in the Development of Mad Maps

The Tension Between Clinical and Peer Work
The Icarus Project comes out of a recent tradition of peer-based mental health organizing and support. We have allies in the Hearing Voices Network, Western Mass Recovery Learning Community, and Intentional Peer Support who all mostly reject the clinical model as oppressive and unhelpful. In my studies this semester I have come to understand some basic ideas about what it is to do “clinical” work. According to Hepworth (2009):

“The term clinical practice is used by some as synonymous with direct practice. Clinical social work practice has been defined as “the provision of mental health services for the diagnosis, treatment and prevention of mental, behavioral and emotional disorders in individuals, families, and groups. (Clinical Social Work Federation, 1997)” The common goal of clinical practice is to “assist clients in coping more effectively with problems of living and improving the quality of their lives.” P.33

There seems to be a standard “helping process” that has three major phases:

“Phase I: Exploration, engagement, assessment and planning
Phase II: Implementation and goal attainment
Phase III: Termination
Phase I includes:

Exploring clients’ problems by eliciting comprehensive data about the person(s) , the problem, and environmental factors, including forces influencing the referral for contact

Establishing rapport and enhancing motivation

Formulating a multidimensional assessment of the problem, identifying systems that play a significant role in the difficulties, and identifying relevant resources that can be tapped or must be developed

Mutually negotiating goals to be accomplished in remedying or alleviating problems and formulating a contract

Making referrals” (P.34)

I can easily imagine a Mad Mapping process taking the form of what is known in the profession as “direct service” The asking of basic question, formulating assessments together, identifying systems that play a role in oppression, developing goals, and making connections are all thing we do for each other as peers in The Icarus Project. I’m interested in what it would look like to create a system of support that followed more “clinical” lines but didn’t have the oppressive aspects of power relationship in the standard clinical relationship. Reading
“Clinical Social Work’s Contribution to a Social Justice Perspective (Swenson)

“Clinical social work should not be equated with practice based on a medical model, a focus on pathology, or social conservatism. Clinical social work includes case management, advocacy, teamwork, meditation, and prevention roles as well as therapeutic or counseling roles. Clinical social workers engage in supervision, organizational change, directing programs, and community education.”

I am very interested in what “supervision” might look like in The Icarus Project. I can imagine it being a very healthy addition to our peer based culture. Furthermore, there are so many clinical tools and psychological concepts that are useful in working with people. In Why We Need a Biopsychosocial Perspective with Vulnerable, Oppressed, and At-Risk Clients, Joan Berzoff states:

“When we work with someone who has been oppressed on the basis of sexual orientation, ability, language, culture, or race, we must also be able to enter into this client’s inner life using an approach that attends to the client’s psychological, social, and biological contexts. In every setting, and with every population, we try to understand how a person has developed psychologically; has taken in and metabolized the social world; has or has not experienced microaggressions based on disability, race, sexual orientation, culture, or language; and might have internalized social stigma. It is important to know how social identities and psychological identities always intersect in any clinical encounter.” (Berzoff, 2011, P.133)

I am really interested in incorporating concepts from drive theory, ego psychology, object relations, attachment theory, self psychology and relational theory into my work with others. I look forward to having supervision from people who can help me along this path of using psychodynamic theories and tools in the service fighting oppression and suffering. I have visions of using Mad Map tools and strategies in doing both group work and 1 on 1 work like case management and coaching.

Differentiating Between Oppression and Suffering
“According to the National Association of Social Workers (NASW), the primary mission of the social work profession is to enhance human well-being and help meet the basic human needs of all people with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty.” (NASW, 1999, p.1)” (Hepworth, 2010, p.6)
I have many years of experience being in a role of support for people who struggle with mental health issues and I have learned to see that often the issues people struggle with are directly related to systemic oppression. Oppression in the sense I am describing is structural, rather than the result of a few individual’s choices or policies. “Its causes are embedded in unquestioning norms, habits, and symbols, in the assumptions underlying institutional rules and the collective consequences of following those rules.” (Young, 2004, p.41) Oppression generally takes the form of racism, sexism, classism, homophobia, or able-ism wherein the dominant group in society subjugates other groups and extracts their labor, wealth, bodies, identity, and dignity, for the benefit of the dominant group. More specifically it manifests as some form of violence, exploitation and exclusion such as police abuse, poor wages, lack of healthcare, homelessness and substandard housing, domestic violence, racial profiling, deportation, etc. (SJL, 2010)

Suffering, on the other hand, is simply a way to describe the painful feelings like anxiety, fear, stress, disappointment, and self-loathing that show up in people’s lives. Suffering is psychological and emotional and often has to do with unresolved issues from our childhoods and deeply imbedded family dynamics. The key difference is that suffering is an internal response to the external conditions that we face. While some suffering is a result of oppression, other suffering is not. In many cases the suffering that poor and working class people, or any exploited group, experience is directly related to the oppression they are subjected to. Police violence, job exploitation, or other forms of oppression can be physically incapacitating (even deadly) and it can also be psychologically and emotionally paralyzing. The fear, doubt, self-hatred, and internalized oppression that can come from these experiences is a form of suffering.
Suffering can be related to oppression, but it can also be generated from other life experiences. My experience, for example, of having so much pressure on me as a child to perform in ways I was never able to, evolved into a paralyzing lack of self-worth as an adult. My mind working differently than most other people around me, and struggling with silent disabilities has shaped my identity as an underdog. I have suffered an enormous amount, enough that I’ve repeatedly ended up in psychiatric hospitals, but it is really different than being subjected to systemic oppression.

 
Mad Maps as Both a Tool For Personal Liberation and Combating Oppression
One of the challenges we’ve had as an organization while working on the Mad Maps project is that there have been competing visions for both what the tool should look like and specifically who we should be gearing it towards. My co-worker, Agustina Vidal, was raised in the aftermath of the dictatorship in Argentina and sees mental health from more of a political/historical lens than a person one. While she see personal mental health issues (what I describe above as “suffering”) as relevant, its not the main focus of her work. In fact, there has been a critique from her and others that the personal focus (as opposed to focusing more explicitly on oppression) has kept The Icarus Project being able to grow and partner with more economically and racially marginalized communities. I think this is a valid claim.

 
The Evolving Race Dynamics in The Icarus Project
The people who started The Icarus Project were not thinking deeply about racism and race dynamics when they started the organization. Much of the culture of Icarus initially came from anarchism and punk rock activist traveler culture going back to the counterculture of the 1960s, which has very white roots (Duncombe, 2011). While we didn’t use the language of “colorblindness” (Abrams, 2009) we played right into many of the classic liberal traps (not talking explicitly about race). It was only some years into the work that it became clear how divided their experience as middle-class white people were from the majority of poor and working class people of color interfacing with the psychiatric system. As a mostly web based community, race was not initially an issue at the forefront of the project. It was only when we started meeting face to face, and groups started forming around the country, that the problematic racial dynamics began to surface.
One of the most confounding issues related to race has to do with the way that mental health issues and and what are considered “racial microaggressions” intersect in a group setting. Derald Wing Sue defines microaggressions as brief, everyday exchanges that send denigrating messages to certain individuals because of their group membership. Sue describes microaggressions at generally happening below the level of awareness of well-intentioned members of the dominant culture. Microaggressions are considered to be different from overt, deliberate acts of bigotry, such as the use of racist epithets, because the people perpetrating microaggressions often intend no offense and are unaware they are causing harm. (Sue, 2007)
As a majority white community, that is also almost entirely composed of people who struggle with serious mental health issues, there is a way that what might be seen as microaggressions are sometimes the behavior of folks who have a hard time relating to anyone. We struggle just to communicate and be seen as “normal” in this world

It is a complex knot to unravel.
On an organizational level, our national collective, which has grown and shrunk over the years (depending on funding,) has, up until recently, been an entirely white staff. Over the course of this past year we have had a number of consultants from different ethnic and racial backgrounds. One issue that has come up has been the language we use to talk about race. At one point in the year we had an Argentinian with light skin, a dark skinned Trinidadian with East Indian heritage, a Jamaican-American , and a handful of Jews and others with European ancestry. The activist culture most of us come from is comfortable using the language of “white” and “ people of color” to explicitly call out the culture of White Supremacy (Kivel, 1995). But our Argentinian and Trinidadian co-workers found it confusing and offensive.
In our attempts to become a multi-racial organization, we have gone through growing pains. In this context, the Mad Maps project is in need of more analysis and voices of people of color. This is a big conversation these days in Icarus, and it comes out in different ways
We are in the process of attempting to synthesize the personal and political in the Mad Maps project, but they are still existing separately in the form of surveys. Agustina wrote the “Madness and Oppression” survey, I wrote the “Personal Mad Maps Questions” survey. I have a clear idea of how to workshop the “Personal Mad Maps” questions, and I don’t feel equipt at this time to present on “Madness and Oppression” or “Intergenerational Trauma.” One obvious solution would be for me to partner with a woman of color to co-facilitate. But there is a larger question of who’s voices should publicly be in the mix.

 
In Person or Online? (or Both?)

My experience, after almost a decade of facilitating Mad Map type workshops is that it’s much easier to have the conversations in a group of people, much more intimidating for folks to do them alone in front of a computer. Another aspect of the Mad Maps project that has yet to be worked out is that a lot of the data we’re collecting is happening online. My initial vision for the data collection would be that it happen in groups of people, in a popular education format. I think it’s often really hard to answer these kinds of tough questions alone in front of a computer screen. Agustina has a vision that we’re going to create an online tool for people to fill out and I’m interested in the potential reach of something like that, but I think it might prove to be more complicated and emotional

How they will be synthesized remains to be seen.
But I think the answer is that both work for different purposes.
How Mad Maps Relates to Our National Organizing Strategy
Since 2006 we have been actively encouraging the formation of local Icarus groups through the use of our downloadable publication Friends Make the Best Medicine – A Guide to Creating Community Mental Health Support Networks (The Icarus Project, 2006). While there have been literally hundreds of Icarus groups started all over the world, without a centralized organizing structure the groups tend to come and go. We are in the process of developing a new national organizing structure and I can imagine Mad Maps playing an important role in the new system.
By its very nature Mad Maps has the capacity to illicit a lot of information. It is incredibly concrete. It was while reading the essay When Oppression is the Pathogen: The Participatory Development of Socially Just Mental Health Practices that it occurred to me we could potentially use the format of Participatory Action Research project.

 
Therefore I will quote extensively from When Oppression is the Pathogen (2009):
A Potential Resolution: Participatory Action Research?
“Participatory action research (PAR) is one of the best known variants among action approaches, described by Kidd and Kral (2005) as “a process in which people (researchers and participants) develop goals and methods, participate in the gathering and analysis of data, and implement the results in a way that will raise critical consciousness and promote change in the lives of those involved – changes that are in the direction and control of the participating group or community.” (p.187) In PAR, therefore, the distinction between researcher and research is challenged, so that participants are given the opportunity to be actively involved in identifying and addressing issues that affect them and their communities (Minkler & Wallerstein, 2003). Such challenges pose challenges for professional researchers: Kidd and Kral (2005) noted that participatory projects can be fraught with ambiguities that can tempt researchers to fall back on the comforts of a less egalitarian model in which they hold more power. As such, researchers must be prepared to engage in personal struggle with their own deeply embedded beliefs about what constitutes knowledge. This idea of personal engagement contradicts the relatively neutral and distant posture to which mental health professionals are traditionally trained—a posture that ultimately separates them from from those with whom they work through the establishment of a power dynamic.”(Italics mine) (Smith, 2009 P.162)
Icarus is hoping to be a part of the wave of organizations leading the way in Participatory Action Research with our Mad Maps project
“Participatory action research, therefore, suggests a direction for mental health professionals who, in keeping with a social justice perspective, would like to (1) contradict the dominant/superordinate power relations inherent in traditional research paradigms, (2) transform therapeutic practice in the context of oppression, and (3) incorporate community knowledge into the creation of transformed interventions.” (Smith, 2009 P.162)

 
Conclusion
Mad Maps has the potential to take many forms, its future will depend part on how skillfully we merge the realms of the personal and political, the clinical and peer. We have plenty of references to draw upon, but we will also have to be thinking outside the box. If we can create something that is useful for the oppressed as well as the “not as oppressed” it will be a powerful tool that can bring many people together. One of the most important aspects of what is considered “mental illness” in our society has to do with communication: our ability to be able to talk to one another in ways we can understand. One of our strengths as The Icarus Project is that our messages cross a lot of boundaries and there is the potential for a lot of cross-racial and cross-class organizing. But we clearly have our own internal work to do in order for this to be possible.
In the meantime, next Fall I plan to have a developed Mad Maps program ready to impliment in New York City with a diverse group of participants. I plan to have clinical supervision to make it happen. Will we use the language and format of Participatory Action Research? How will we integrate supervision (clinical or otherwise into The Icarus Project) How will we balance the complex power dynamics of peer and professional? All of this remains to be seen. In the meantime, I am grateful to have had the opportunity to engage with all of this thought provoking materials in the context of a social work program at Silberman.

 

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