© Barbara F. Meyers 2011. All Rights Reserved.
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I am one of the lucky ones. In dealing with my mental health challenges, I had the blessings of good health, financial security, a home, a supportive and loving family, a good education, a meaningful vocation, and even though I have a mental disorder, it is easily treated by a doctor who has taught me a lot about life and living.
In my work in my mental health ministry, I have met many people who do not have all of these advantages. In fact, some have none of them. They are largely invisible to the rest of us until some catastrophe occurs. For many of them, each day is a struggle in a society that basically kicks them around.
Today I'm going to talk about the ways that people are oppressed, because I want you to see what some people live with and to consider what our response to this situation as religious people and a religious community can be.
Jails and Prisons
The Unitarian Dorothea Dix was the foremost crusader for mentally ill people in the United States in the mid-1800s. A felt sense of religious calling and purpose is what drove her to do this work. Dix's career as a reformer began in 1841 when she visited a jail and noticed that there were some insane prisoners who were being kept there in deplorable conditions. Her instant compassion for them was the beginning of her life's calling. In 1843, her report Memorial: To the Legislature of Massachusetts, in which she presented the results of her survey of the state's insane people, gave many shocking details of how they were being treated. In many instances they were kept chained in an enclosed space, lying in their own filth, without adequate clothing, and abused physically and sexually. It was thought by many that they couldn't feel cold because their minds were deranged, and some were kept naked without heat, even in the winter.
Though Dix's crusading efforts, things started to change. She eventually contributed to the start of 30 mental hospitals in the United States during her career.
What happened to these mental hospitals? In short, they had lack of adequate funding, and thus staffing. In time, they became "snake-pits" and there was clamoring for their closing to be replaced by caring for mentally ill people in a community setting. We all know what happened: the funding for community support was slow and inadequate to materialize. It was always the first thing cut out of budgets to save money. Today, many mentally ill people live on the streets or in jail or prison.
People kept naked? Surely this is the mark of a bygone era. Or is it? I was shocked to learn that some prisoners are kept naked even today. A 2007 TV news story about mental health care in a Los Angeles jail has footage of unclad prisoners in their cells. Bradley Manning, the leaker of Wiki-leaks has been kept naked in his cell. This degrading treatment is shocking to me and certainly doesn't contribute to improving the mental health of the prisoners. I don't think it reflects well on our society that this continues to happen.
Human Rights Watch has remarked about the care that prisoners get when incarcerated that, "The failure of US prisons to address adequately the special needs of prisoners with serious mental illness ... flies in the face of international human rights standards." [1]
The situation today is not dissimilar to that when Dorothea Dix did her work. If she were to come back today, she would feel right at home. Mentally ill naked people kept naked in prison. Even today.
But, prisoners aren't the only ones who are or have been oppressed because of their mental illness.
Soldiers
Some soldiers coming back from the wars in Iraq and Afghanistan are returning with serious psychological problems that are related to their service. Yet, too often, there is a lack of adequate treatment after they return. For a while there was a policy of wrongly classifying troubled returning soldiers as having pre-existing personality disorders, so they wouldn't have to be provided treatment. When this was widely publicized, the policy was changed. In recent months, the Veterans Administration has tried very hard to overcome this problem and meet the needs of returning veterans, but the problem overwhelms them and will get bigger.
African-American Men
I've met many African-American men in Alameda County who have been diagnosed as having schizophrenia. In getting to know them, many don't seem to be more seriously disturbed than people with less serious diagnoses. In fact, many studies have shown that African-American men are more likely to be over-diagnosed as having schizophrenia and white men are more likely to be under-diagnosed as having mood disorders. There are far more African American men in our county's public psychiatric hospital, John George, than their percentage in the general population. Having a diagnosis of schizophrenia will mean that people will be prescribed powerful anti-psychotic medication, have longer hospitalizations and are likely to be treated as if there is no hope for their living a full life.
Why does this happen, even among doctors who are trying to treat them fairly and without bias? An article exploring this issue in the Journal of Health and Social Behavior [2], researchers state that, "A doctor who chooses to treat all patients the same regardless of race may make diagnostic mistakes to the extent that a patient's symptoms differ from the prototypical descriptions in the DSM, [the Diagnostic and Statistical Manual, the document used to diagnose mental illness]. To change this, clinicians should make adjustments in how they reach to a diagnosis (i.e., the questions they ask, the words they use, the type and amount of information they seek, etc.) on the basis of the patient's race." This takes special understanding and training that usually aren't part of clinical education.
Past Practices
Let's look at some past practices in the United States to illustrate that, just because something is widely believed and practiced in the mental health system, doesn't make it right.
In the mid 1800's married women could be hospitalized at a husband's request without the evidence required in other cases. In 1860, Elizabeth Packard, who differed with the theology of her clergyman husband, was forcibly placed in an Illinois state hospital where she remained for 3 years. This is what one of Dorothea Dix's hospitals was used for.
When the field of Eugenics was popular in the early 1900's, compulsory sterilization laws were adopted by over 30 states and 60,000 mentally ill and disabled people and those socially disadvantaged were sterilized in this country in the first decades of the 20th century. In fact, some sterilizations continued into the 1970's.
Lobotomy, which involved cutting the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain, was popularized in this country by Dr. Walter Freeman, an American physician who did tens of thousands such operations, and even invented the process of "ice-pick lobotomy" to make it go faster. He recommended the procedure for everything from psychosis to depression to neurosis to criminality and even did it on a 12-year-old boy in 1960 in Santa Clara County.
Electro Convulsive Therapy, or ECT, formerly known as electroshock, is usually used to help in treatment of severe depression when drug and other therapies haven't been successful. It gained widespread use as a form of treatment in the 1940s and 1950s, and was sometimes given without the patient's consent.
After going out of practice due to pressure by former patients and ethicists, has made a come-back in recent years with more safety procedures being used. There is a lot of ECT performed at Stanford Hospital and Herrick Hospital in Berkeley. People have reported to me that it has been forced on them, even today, by denying these desperate people any more mental health treatment unless they agree to the procedure, or by having conservators request it over the patient's objections.
I have talked to many people who have had ECT and the responses vary widely. I've heard "Thank God for ECT. It saved my life." I've also heard, "It is barbaric and cruel and should be outlawed." The controversy continues. Given this, it is clear, to me anyway, that it should only be given with informed consent.
Hegemony
Let's talk about the hegemony of American mental health care
In a recent book Crazy Like Us, Ethan Watters says: "We may have yet to face one of the most remarkable effects of American-led globalization. We have for many years been busily engaged in a grand project of Americanizing the world's understanding of mental health and illness. We may indeed be far along in homogenizing the way the world goes mad." [3]
He continues, "We've been changing not only the treatments but also the expression of mental illness in other cultures. Indeed, a handful of mental-health disorders - depression, post-traumatic stress disorder and anorexia among them - now appear to be spreading across cultures with the speed of contagious diseases. These symptom clusters are becoming the lingua franca of human suffering, replacing indigenous forms of mental illness." How can this be? Surely, what mental illness is must have some commonality across human-kind. But, not so fast. Some researchers feel that there is a lot of evidence that "mental illnesses have never been the same the world over (either in prevalence or in form) but are shaped by the ethos of particular times and places." And, they change over time. For example:
Speaking of a sudden explosion of cases of the eating disorder anorexia nervosa in Hong Kong, Dr. Sing Lee, a psychiatrist and researcher at the Chinese University of Hong Kong stated that "western ideas did not simply obscure the understanding of anorexia in Hong Kong; they also may have changed the expression of the illness itself." [4]
"Culture shapes the way general psychopathology is going to be translated partially or completely into specific psychopathology," Lee says. "When there is a cultural atmosphere in which professionals, the media, schools, doctors, psychologists all recognize and endorse and talk about and publicize eating disorders, then people can be triggered to consciously or unconsciously pick eating-disorder pathology as a way to express that conflict."
Lee continues, "Some ... have suggested that we are investing our great wealth in researching and treating mental illness ... because we have rather suddenly lost older belief systems that once gave meaning and context to mental suffering." I agree with him. I believe this insight suggests a response from the religious community, for making meaning is one of the great purposes of religion throughout history.
Our Responsibility as Religious People - Meaning Makers, Comfort and Hope Givers, Advocates
I see our responsibility as religious people to be meaning makers and givers of comfort and hope to those who are lost and most need it. And, that we become advocates for more humane care. These are among the best things the faith community can do to curb mental illness in ourselves and others. If mental illness is a cultural expression of mental suffering, I suggest we become agents of cultural change.
Story: Laszlo Kiss
When I was in seminary a visiting Transylvanian scholar the Rev. Lazlo Kiss told us a story. Laszlo was the minister in a small village in Transylvania. One day he visited a parishioner who had moved to a home for the elderly in a near-by town. He told us of the shock he felt when he walked in and found people ware-housed, stacked in unclean bunk beds several to a room, and how the general appearance of the facility was that it was a place for discarded human beings that no one wanted.
But the residents heard that he was coming and was going to do holy communion for his parishioner. They were all excited. They wanted to have holy communion, too. It became the most important thing in their lives that day that they would be able to participate in the ritual. They all lined up like children and waited patiently for their turn to have holy communion. It made a significant impression on Laszlo, and when he told it to our class, it made an impression on me.
These were people who had been physically removed from the only society that they knew, a society that was based on very close social ties in a small village. They had been discarded, as if their lives didn't matter anymore.
And, yet when Laszlo showed up with his communion cup, their faces lit up. God was still available to them. God was listening. The importance of religion and what it can do to one's psychological outlook is so striking that it can bring tears to my eyes just remembering the story. And, although this is a story about Transylvania, I know that there are examples of people in old age homes in our own country, mentally confused, who are cut off from their religions.
We Are All God's Children
My friends, we are all God's children. It is a scandal that elderly people have been denied the ability to worship, especially at a time in their lives when faith could be most helpful. It is a scandal that prisoners are kept naked and that prisons are our new mental asylums. It is a scandal that African-American men are disproportionately diagnosed with schizophrenia. It is a scandal that returning soldiers aren't getting adequate care. It is a scandal that people are being given ECT without their consent. I could go on with scandals about how the graves of patients who died in mental hospitals weren't marked, about LGBT youth, about children in foster care, about sub-standard board-and-care facilities, about the fact that people with mental illness have a life-span 25 years shorter than the general population, and about the fact that many people with severe mental illness are drugged into a stupor and do nothing but smoke and watch TV all day. These are people who our society has somehow decided don't matter.
But, we know better. Our Unitarian Universalist faith teaches us that each precious person has inherent worth and dignity. Nobody has the right to take away hope from people who need it the most. I believe we have a religious obligation to change these scandalous situations to the extent we can.
All is not totally bleak. There are some recent positive developments: passage of the Mental Health Services act in California, changes in the practice of restraints and seclusion, mental health courts, PTSD treatment improvements, and more. We must celebrate and continue to make these kinds of improvements.
Recent studies [5] suggest that religious activities and beliefs can be particularly important for persons who are experiencing more severe psychiatric symptoms, and increased religious activity such as prayer, attending religious services, meditation or meeting with a spiritual leader, is associated with reducing those symptoms.
While the professional mental health community is belatedly coming to widely understand the importance of religion in a person's mental health, unfortunately many ministers don't know how to deal with the mental health problems they find in their congregations. I've been part of a team of faith leaders in Alameda County that is teaching mental health clinicians about spirituality, and teaching faith leaders about mental health. I also teach mental health workshops to UU audiences across the country. I consider this to be some of the most important work of my ministry.
What we can do
What then can we as religious people do to help this problem? First, we can get educated about mental health. I have written a curriculum on this subject and have presented it at our congregation several years ago. Maybe it's time for a refresher course. After we get educated, we can participate in advocacy on mental health issues, which could take many forms; supporting legislation, joining the National Alliance on Mental Illness (NAMI) and get involved in its activities, or in our congregation, joining the MPUUC mental health committee. Our committee has been involved in the yearly NAMI walk, having movie nights with discussion after the movie, donating and wrapping gifts for patients at John George, and some after service congregational get togethers. I produce a public access TV program called Mental Health Matters the purpose of which is to give the community at large information and hope. I can testify that befriending someone who is mentally ill is mutually rewarding.
I can definitely see expanding on this: maybe visiting elders in nursing homes, or offering respite care for family members, or working with LGBT or foster children. Or maybe you have an idea for my TV show.
Our parish minister the Rev. Jeremy Nickel has been involved in visiting a prisoner. Involvement with spiritual/religious support/advocacy keeps people out of lives of crime and thus out of prison. How better could we live out Dorothea Dix's legacy to get involved in activities like this?
If any of you are interested in any of these, or if you have ideas for other activities, I'd love to talk to you. Let's do our part to help "the arc of the moral universe bend towards justice."
Conclusion
It is always an inspiration to me that the people I work with still wake up each day, and try their very best to meet the day despite problems of serious mental problems, doing this in a society that basically kicks them around. They keep on trying with great courage to survive and find meaning in their lives. These people are my mentors and heroes.
Being with people with mental disabilities, myself included, has taught me to see the holy in their faces, and to accept them just as they are, with their limitations and pain, but also with their gifts, and their beauty and their capacity to grow.
I intend to use my relatively privileged position to try to make the world a kinder place for them to live in. I invite you to join me in this effort.
May it be so.
Amen.
Footnotes
I wish to thank Rev. Dr. Devorah Greenstein who taught a class at Starr King School for the ministry on Mental Illness and Oppression in the United States in the Spring semester 2011. Many of the readings mentioned in this talk were introduced to me in that class.
[1] A Corrections Quandary: Mental Illness and Prison Rules by Jamie Fellner, Human Rights Watch, 2006.
[2] Racial Differences in DSM Diagnosis Using a Semi-Structured Instrument: The Importance of Clinical Judgment in the Diagnosis of African Americans, by Harold W. Neighbors, Steven J. Trierweiler, Brigett C. Ford, and Jordana R. Muroff, The University of Michigan, Journal of Health and Social Behavior 2003, Vol 43 (September) 237-256.
[3] Crazy Like Us- The Globalization of the American Psyche by Ethan Watters, Free Press, 2010, Introduction.
[4] Crazy Like Us- The Globalization of the American Psyche by Ethan Watters, Free Press, 2010, Chapter 1.
[5] "Religion may serve as a pervasive and potentially effective method of coping for persons with mental illness, thus warranting its integration into psychiatric and psychological practice." Psychiatric Services 52:660-665, 2001. The Prevalence of Religious Coping Among Persons With Persistent Mental Illness by Leslie Tepper, Ph.D., Steven A. Rogers, M.A. Esther M. Coleman, Ph.D., and H. Newton Malony, Ph.D.