Reflection on the Ideology Behind the Tools (P. 2)
Comparing Wellness Management and Internal Family Systems thinking
Wellness Management
(This is part 2, you can find Part 1 here.)
A few years ago when I was still working in the public mental health system I was introduced to an article entitled The (Un)managed Self: Paradoxical Forms of Agency in Self-Management of Bipolar Disorder. It was 35 pages long and fairly academic, but I found it deeply compelling and relatable. At the heart of the writing was this critique of “wellness management” as a strategy for dealing with mental illness, specifically bipolar disorder. By reading popular bipolar self-help literature at the time (2011) and attending support groups, the author drew the conclusion that there was something off about the way agency was being formulated: the biomedical model was based on separating personhood from pathology, as if either one of these individual formulations could be isolated. In other words, the idea that there is a healthy “self” that is separate from a “disease” creates a worldview where we need to be vigilant and suspicious towards our thoughts to keep our illness in check, and it doesn’t leave much room for deeper explorations of our internal world.
For those of us who struggle with bipolar disorder and related madness, this idea of wellness management can be a compelling worldview. It can feel sometimes like our brains are sick and they get us in trouble and we need to make sure they don’t get out of control, they need to be managed. Especially if the only language we are given is a language of pathology and disorder, using “self-management practices” can seem very appropriate. But this medicalization, this “disease model” of mental illness, leaves out some critical pieces of the puzzle that makes it hard to get a clearer grasp of what might be happening, and what we can do about it.
Protectors & Exiles
Around the same time we started using the idea of WRAP plans in the Icarus Project community and calling them Mad Maps (2005), Jacks and I were introduced to another model for thinking about our mental health issues called Internal Family Systems. At the heart of the IFS model is the idea that everyone has multiple parts inside of them that have relationships to each other, and everyone has a Self that is fundamentally curious, compassionate, courageous, and creative. This sounds like it has something in common with the biomedical model, as there is also a separate “self” that can be isolated and is the ideal actor and observer, but in the IFS model the parts form a complex family rather than simply a “disease.” They have their own opinions about what is happening and what to do about it. And sometimes they know each other, but often times they think they’re acting alone, stuck in a past trauma loop. If we can “unblend” from our parts it is possible to think and act from Self. This perspective makes an enormous difference in how we think about our internal worlds.
According to the Internal Family Systems model, we all have protector parts and exile parts and they have a close relationship with each other. There are two types of protector parts: managers and firefighters. (For a closer examination of the IFS model check out the article in my dad blog Puzzles & Locks.) From an IFS perspective, a “wellness management” document like a WRAP plan would be dominated by the perspectives of manager parts, meaning: the parts of ourselves that carry huge burdens of responsibility for keeping life together and protecting us from anything that leads to vulnerability, pain and instability. Our own manager parts can ally with other people’s manager parts, and they can mask the existence and importance of exiled parts. But the exiles are a critical piece of our internal systems.
So in the example of a WRAP plan, one of the questions built into the model is “What are the warning signs that I’m having a hard time?” This is a great question, and it can be a very useful one. For years I’ve used my own T-MAPs plans to help explain to loved ones what it looks like when I’m struggling so that they can better know how to be there for me. Here’s some personal responses I’ve written before in my own T-MAPs document:
Early Warning Signs Pointing Towards Mania…
Talking about not getting enough sleep for more than 3 days in a row
Interrupting people in conversation and not listening well
I appear to be talking really fast. I start new sentences before finishing the old ones.
Unable to finish the tasks I’ve taken on
Unusual expressions of anger - inflexible and rigid in thought
These “warning signs” are well articulated (if I do say so myself…) but they are taken out of context and there is no mention of WHY it is I experience these issues. They are written as if they are symptoms of an illness. What I am suggesting here is not that they be thrown away, but that if we are engaged in a transformative healing process that there is some deeper exploration about what is underneath the surface. If we see them as symptoms of “bipolar disorder” then the question of why they exist is already answered for us. A list like this can be helpful, but we can also use it to police ourselves and allow others to police us.
Curiosity and Compassion
It’s very hard to do Internal Family System’s work without a deep sense of curiosity and compassion. It can often help to engage someone else, like a therapist, in our internal process to help engage our own curiosity and compassion. From a manager part perspective, a sentence like:
Unable to finish the tasks I’ve taken on
sounds like an obvious pathology that needs to be corrected, or as a “warning sign” that something is wrong.
With enough space, a deeper examination from Self might look something like:
Unable to finish the tasks I’ve taken on
One way to interpret this inability to finish tasks is that when I’m “scattered” it is usually because I am scared of something and my parts are stirred up. Can I notice the stirred up parts and ask them to step back to engage with the fear? The flutter of scattered thoughts are often my way of trying to ignore the fear, and the fear is often of depression, or of losing control of my life when I get depressed. There are a few different reasons I tend toward depression, but they often have their origins in young parts inside me that feel ignored, that are sad about early death in my life, a deep loneliness I’ve carried with me from childhood based on my complex upbringing. So underneath the depression is a sadness that, if I can reach, if I can feel, there is a chance for emotional release. And underneath that release…is Self energy, more curiosity and compassion.) So it looks something like:
scatterness---> fear---> depression --> sadness—>Self
I’ve come to recognize that inside of my internal system are clusters of parts that have memories and emotions and opinions that often differ from each other. The more I talk to them (in therapy, in my journal, and just on my own in daily life), the more I build relationships with them, the more I recognize their particular styles when they show up, and instead of just being scared of my unprocessed internal feelings, it’s like having a relationship with an internal family of familiar parts. Many of them are childlike, because they originally developed when I was a kid to take care of me. My manager parts are like parentified children: they think they’re supposed to be in charge running the show, and when I engage with them from my curious and compassionate Self and they see I’m a grown up, they step back, and have the opportunity to take on different roles. My exiles carry old burdens and with patience and curiosity I can help them unburden. This is a way of internal systems shifting and evolving.
This way of thinking may feel foreign or abstract, or maybe like science fiction, but I guarantee you it’s not only real, it can be a very effective way to engage with people. I do it with myself and I do it with my clients. If I thought I just had a biological brain disease then there would be little reason for me to put in the work to connect to my parts. So I’m all for talking about “warning signs” but I want it to be in this kind of context and divorced from the medical model that only knows how to talk about “symptoms” and “illness.” My life is way more interesting than that. And so is yours.
Family Systems Thinking
At the heart of IFS is the ideology of Systemic Family Therapy which has its own roots in systems thinking: the idea that “mental illness” is never just about an individual, it’s about the larger systems connected to that individual. In this view, when someone gets a diagnosis of “bipolar disorder” or “schizophrenia” there very well might be a biological aspect to their situation, but the way their “illness” manifest is a reflection of their family system, and the larger social system they live in. It’s like being a canary in a coalmine who gets sick before anyone else. It’s also often a way that family systems get to ignore their own problems by focusing all the energy on the “sick” member.
This way of thinking was very popular in the late 1960s and 70s but it fell out of fashion with the rise of biopsychiatry in the 1980s. Many idea from systems thinking are still popular in family therapy, but in the realm of “serious mental illness” they are rarely talked about. And there are some interesting politics behind this that have to do with the confluence of of pharmaceutical companies and family advocacy organizations like the National Alliance for the Mentally Ill (NAMI). It can be seen as a backlash against psychoanalysis where there was often a lot of unhelpful blaming of families for their children’s mental illness.
Conclusion
But as a society we clearly swung in the whole other direction and it sure seems like it’s time to revisit some of those older philosophies. Personally, as someone diagnosed with bipolar disorder myself, and someone who works with many others that are similarly diagnosed, I find a systems thinking perspective a lot more useful and empowering than the ideology of biopsychiatry. In many ways IFS is a modern vehicle for the ideology of systems thinking. I’m going to keep exploring what it might look like to develop a practical mapping tool for internal and external communication about mental health issues using IFS and systems thinking. If you want to join me and be a part of the conversation please be in touch!
I’m grateful for all the work done by others including Mary Ellen Copeland who developed WRAP, Dick Schwartz who developed IFS, and the countless folks from the Icarus Project and related ventures that have been experimenting with Mad Maps and T-MAPs. I’m really looking forward to taking this conversation to a whole new level in the coming months and years.
Re-Orienting to Emergency: A Slower Urgency
To learn more, please visit: https://www.idha-nyc.org/crossroads-of-crisis
*ASL and live closed captioning provided*
NOTE: 3 CE credits are available for this class. Learn more about CE credits at IDHA here.
Class Description
What is crisis? Where does it come from? Who decides? We have all been socialized to embody a definition of, and reaction to, a “crisis.” While some of this conditioning is easily accessible, other parts live beyond our perceptions within our histories, cells, and ancestral knowings. What shaping forces have been part of our definitions and reactions to “crisis?” Could it be that how we have been taught to think and act in a crisis is itself part of the crisis?*
After many weeks of communally cogitating about crisis in this training series, this class will serve as a pause, a reset, a provocation, and a deep dive into our body-spirit-minds. Participants will be invited to consider the forgotten etymology of the word “crisis” as an opportunity to sieve and document rather than urgently react. We will reflect about how we live individually and collectively in relation to modern notions of crisis. What needs to be unearthed in us? What needs to be composted? In what ways might our inherited sense of crisis be reimagined as opportunity, awakening, even cracks through which new light emerges? The opposite of a question is not always an answer, but a story that leads to re-orientation. In that spirit, this class will sow seeds of new ways of thinking and being together in families, communities, and systems, resourcing us to create spaces where every member is held, honored, safe, connected, settled, and resourced.
*This question/provocation has been posed by Bayo Akomolafe in his essay “A Slower Urgency”
Learning Objectives
Analyze inherited cultural understandings of what crisis is, examining how crisis has shaped personal and communal experiences
Practice what it means to be “ready” for crisis and apply this to particular contexts
Demonstrate an understanding of power/positionality in relationship and locate this sensing within the practice of determining crisis and the layers of relationship that support readiness for it
Integrate body-based practices as a source of knowledge and also to incorporate new learnings into mind, body, and spirit
Faculty
Susan Raffo (she/her) is a writer, cultural worker and bodyworker who does much of her work through the Healing Histories Project, a national project focused on transforming the medical industrial complex, as well as locally as a core group member of REP, a Black-led network showing up to support others in moments of crisis or urgency, with care and respect for the full dignity and autonomy of those in crisis. Raffo is the author of Queerly Classed (1997), Restricted Access (1999), and Liberated to the Bone (forthcoming AK Press: 2022). You can find her writing and other work at www.susanraffo.com.
Cara Page is a Black Queer Feminist cultural/memory worker, curator, and organizer. For the past 30+ years, she has organized with Black, Indigenous and People of Color, Queer/Trans/Lesbian/Gay/Bi/Intersex/Gender Non-Conforming liberation movements in the US & Global South at the intersections of racial, gender & economic justice, reproductive justice, healing justice and transformative justice. She is leading a new project, Changing Frequencies, an archival/memory and cultural organizing project building power with communities who want to confront, heal from & transform the historical and contemporary exploitative practices and abuses of the Medical Industrial Complex (MIC). She is also co-founder of the Kindred Southern Healing Justice Collective.
What You Get
Registration includes the 3-hour class session, an optional 90-minute discussion group one week after the live class (Sunday, May 14 from 12-1:30 pm EST), and access to IDHA’s School for Transformative Mental Health on Mighty Networks (our virtual learning community where you’ll have the opportunity to engage with other students and your faculty).
Really helpful breakdown of IFS; I realize now that I've been carrying around a really limited understanding of it, and will go deeper. I love the book collage so much and it makes me want to read the Lynn Hoffman book
I'm unintentionally writing a series of posts that fit together and fleshes out the vision for using IFS philosophy in a mapping tool like T-MAPs. Here's the latest one. https://undergroundtransmissions.substack.com/p/the-most-alive