CARING CONGREGATIONS

© Rev. Barbara F. Meyers 2003. All Rights Reserved.
Mission Peak Unitarian Universalist Congregation
June 1, 2003

Charming, determined and self-effacing, the Unitarian Dorothea Lynde Dix was the foremost crusader for the mentally ill in the United States in the mid-1800s. In an era when women didn’t have the right to vote, she managed by sheer force of will, hard work, and astuteness to convince legislatures in many states to appropriate public funds to build over 30 hospitals for the care of the seriously mentally ill. She was deeply religious, having been raised by her grandmother to be a Unitarian, later worshiping in the church of the Rev. William Ellery Channing, the founder of American Unitarianism, beginning in 1823. The sense of religious purpose in her life is what drove her to her acts of public service.

When the early and mid-1800’s saw the beginning of compassionate methods of caring for the mentally ill, Universalists and Unitarians from both the medical and social reform communities were prominent in developing and promoting them. A deeply felt religious sensibility, especially the belief in the inherent worth of each human soul, and the conviction that they had a responsibility to improve life in this world, is what motivated this work. These tenets have been and remain at the core of Universalist and Unitarian belief systems.

Today, I’ll talk about some of the Unitarians and Universalists who have worked on behalf of mental health care, and end by giving a vision of what I see as a possible future in support of mental health care for us as a Unitarian Universalists as a congregation and as a denomination.

First, a Perspective:

A film recently produced by an anti-stigma campaign by the Royal College of psychiatrists in Britain begins by stating, “You can judge a civilization by how it treats its mentally ill.” It is instructive to keep these words in mind when listening to the history that I will relate.

It is fair to say that mental disease has always existed among humankind. From the earliest of times, there have been associations of both heavenly and demonic with mental illness. In colonial times the seriously mentally ill were cared for chiefly at home by their families. The insane who could not be cared for by their families were sent to local almshouses and jails, institutions that didn’t have the facilities or ability to care for them. Often, they were kept in the most deplorable conditions, as Dorothea Dix discovered when she made surveys of the States. As Dix found, in many instances the mad 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 the insane couldn’t feel cold because their minds were deranged, and thus they were kept without heat, even in the winter.

The earliest hospitals serving the insane came in the larger cities of Philadelphia and Williamsburg. Asylums in North America were built starting in the early- to mid- 1800’s following a model of care developed in Paris and York, England. The founders of these institutions proposed that the mentally ill be treated with kindness, removing the chains that restrained them. Their success with this “moral treatment” was encouraging and widely known.

After an initial building period, many of the asylums became under funded and over crowded, and the goals for humanitarian care were compromised. “Large numbers of chronic and aged patients led to a fundamental transformation in the character of mental hospitals. � Slowly the positive images of hospitals that had prevailed in the mid-nineteenth century gave way to far more negative ones associated with hopelessness, abuse and untimely death. By World War II mental hospitals were identified as ‘snake pits’�” By the mid-1900’s the consensus was that the mentally ill could better be cared for in local communities, and a deinstitutionalization of these people began. However, support necessary for their care in the local communities was largely not forthcoming. Many of these people ended up on the streets or in jails. It seems that in some ways, we have come full circle from the time that Dorothea Dix began her crusade. It is widely acknowledged, including by the Surgeon General of the United States, that there is currently a crisis in mental health care in the United States.

With this introduction, I’ll now introduce three of the most prominent figures in mental health care n the 1800’s.

Dr. Benjamin Rush, the first leader in the treatment of the mentally ill in the United States, was a prominent physician, and a signer of the Declaration of Independence, and Member of the State convention that ratified the constitution in 1787. Rush was raised as a Presbyterian and attended a number of churches throughout his lifetime. Although never signing the membership book of a Universalist church, he clearly held Universalist beliefs, often attending a Universalist church in Philadelphia, and the Universalists claim him as one of their own.

When he began his career at Pennsylvania Hospital there were several locked cells for the insane, then often called “lunatics”, “aliens”, or “distracted persons”, which greatly interested Rush. He soon became an advocate for humane treatment of these people, protesting the inhumane conditions they were being kept: “Putting mad people in cells is dishonorable to science and humanity of Philadelphia,” he wrote. Since he was a distinguished physician, he was able to publish articles in the newspapers and with the Legislature, people listened. His advocacy procured a state appropriation to open an insane ward at Pennsylvania Hospital which was completed in 1796. This was the first time that the insane had heat in the rooms that they occupied.

With the patients in this ward, he began to develop his innovative treatments for the insane. He became one of the first people to suggest that mental illness is subject to physical influences and may be cured with scientific treatment. A great number of the therapies he developed were far in advance of their time. These included diet, rest, exercise, occupational therapy, productive work, travel, diversion, music, and even a primitive version of “talk therapy”. Above all, he advocated that the mad be treated with dignity, truthfulness, sincerity, respect and sympathy. He is now regarded as the “Father of American Psychiatry”, and his portrait appears on the seal of the American Psychiatric Association.

Rush’s religious views were deeply held and strongly influenced his actions throughout his life. He believed the mind was the receptacle of the presence of Deity in mankind, and that in the mind, human beings had a “sense of Deity”, a religious sense. His compassionate work with the insane was a living out of his religious belief that in curing the mind, he was allowing a person to exercise this sense and thus access the presence of the Deity.

Dorothea Dix

Dorothea Dix’s career as a reformer began when, in 1841 after returning to Boston, she was asked to take over a Sunday school class at the Middlesex County House of Correction in East Cambridge. After teaching her lesson to the women prisoners, she noticed that there were some insane prisoners who were being kept at the jail. Her instant compassion for these insane prisoners was the beginning of her life’s calling. Soon thereafter, she was able to visit the Worcester State Lunatic Hospital, and saw the kind of humane care that was being given there. In 1843, she was appointed to make a survey of the almshouses and jails in Massachusetts to chronicle the conditions in which the insane were being kept. Her report Memorial: To the Legislature of Massachusetts gave many shocking details of how the insane were being treated. Her observations were specific, shocking and overwhelming. Here are some examples: “Medford. One idiotic subject chained, and one in a close stall for 17 years” “Granville. One often closely confined; now losing the use of his limbs from want of exercise.” “Shelburne. I saw a human being, partially extended, cast upon his back amidst a mass of filth. The mistress says ‘He’s cleaned out now and then; but what’s the use for such a creature?’ ” “Barnstable: Four females in pens and stalls; two chained certain, I think all.” “Bolton: � ‘Oh I want some clothes’, said the lunatic ‘I’m so cold.’ � One is continually amazed at the tenacity of life in these persons. … Picture their condition! Place yourselves in that dreary cage, remote from the inhabited dwelling, alone by day and by night, without fire, without clothes, without object or employment� No act or voice of kindness makes sunshine in the heart,” she wrote. Clearly, she had heart-felt compassion for the unfortunate insane people and was deeply shocked and angered at what she found.

Her Memorial documenting these conditions was presented to the Massachusetts State Legislature and was immediately reprinted in pamphlet form so it could be distributed to the public. It created a public uproar. Several communities denounced her report as not being accurate, and consisting of her fantasies. Other supporters rushed to her rescue with counter attacks. Interestingly, “her sterling character as a witness”, and her position as a woman and thus “ineligible for political advantage” worked in her favor. The Massachusetts Legislature acted upon by their passing an appropriation to increase the capacity of Worcester hospital by 150 beds. She would later point to this as her first achievement on behalf of the insane.

It can be said that in this first campaign, Dix learned the techniques that she would use successfully in many other situations. She would do detailed research and homework as to the conditions in a location. She would then present these findings to the appropriate legislative body, cultivating the sponsorship of influential people and sympathetic law makers, and she would publish the results of her work in Memorials. Among the Memorials she prepared were those to New York in 1844, New Jersey in 1845, Pennsylvania in 1845, Kentucky in 1846, Tennessee in 1847, North Carolina in 1848, Mississippi in 1850, and Maryland in 1852. During her career, she visited every state east of Colorado to persuade legislatures to take measures for the relief of the insane. In time, 30 hospitals were built directly attributable to her efforts as a reformer.

Dr. Joseph Workman

Dr. Joseph Workman, known as the “Father of Canadian Psychiatry,” was an immigrant to Canada from Ireland in 1829. He was one of the first doctors to be educated in Canada, graduating from the fledgling McGill University in 1835. His was a pioneering and public minded spirit, being on the ground floor of expanding a school system, building a Unitarian church, and creating an asylum in the new city of Toronto. Throughout his life, he had a fierce tenacity of purpose, a sense of justice and the ability to learn from his mistakes.

In 1853 he was appointed the interim Superintendent of the Provincial Lunatic Asylum in Toronto, becoming the permanent Superintendent a year later. It was a post he held until 1875. The asylum had been created in 1841 in an old jail described as “unfit for felons” [!] It was initially filled with seventeen patients who previously had been chained to the wall in the basement. In 1850 a new Asylum was built on 150 acres of land outside the center of the city.

Under Workman’s tenure, the Asylum became a modern institution and made him famous for his methods of dealing with the insane. His innovative treatment included allowing patients freedom, promoted healthy living conditions for asylum inmates, and occupational therapy in the gardens, farm or with textiles.

Since the time of Rush, Dix and Workman there have been other Unitarians and Universalists who have worked on behalf of the mentally ill, although not as prominently as these three. A number of ministers and theologians have made this a central issue for their ministries and authored resolutions to be considered by the Unitarian Universalist General Assembly.

So far, I have focused on situations of severe mental disorders. As most of us know, the experience of episodes of milder forms of mental disorder is also the part of many lives. In any given year, about 20% of adult Americans will be affected by a mental disorder, with nearly half affected at sometime in their lifetimes. The most commonly occurring mental disorders in the population are anxiety disorders such as panic attacks, phobias and obsessive-compulsive disorder, mood disorders such as depression and bipolar disorder, and substance abuse disorders. It is probably fair to say that there are only a few families that haven’t in some way been impacted by mental disorders in one or more of its members. As those of us who have had this experience know, living in this situation can be devastating and have lasting impacts on the lives of all people involved, including the ones whose loved one has the disorder.

As I can personally attest, living with such a disorder in oneself or in one’s family can be very difficult. There is significant stigma against mental disorders in our society, a stigma which is at its most harmful when it is internalized by those experiencing the disorder or their family members.

In my own case, my becoming a part of a faith community was very important in my being able to live with my illness. There has been a fair amount of recent research on the effect of religion on various mental disorders. Although studies aren’t unanimous in their views, there is a wide consensus that religiosity is beneficial for a large variety of mental disorders. Reasons given by those making the argument that religion is generally beneficial to mental health are that religion:

1. Reduces existential anxiety by offering a structure in a chaotic world
2. Offers a sense of hope, meaning, and purpose, and thus emotional well-being
3. Affords solutions to many kinds of emotional and situational conflicts
4. Establishes moral guidelines to serve self and others
5. Promotes social cohesion
6. Offers a social identity and a place to belong
7. Provides a foundation for cathartic collectively enacted ritual
8. Offers a place where we can explore the meaning of the gifts that doing through a difficult situation can bring to one’s life – gifts of vulnerability, discovering one’s authentic self, patience, living with paradox, creativity and hope.

My hope is that we can build communities of faith that can help not only the cause of the most severely mentally ill, like Dix, Rush and Workman, but also the overwhelming numbers of people who suffer silently and are afraid to talk about it and allow the healing aspects that religion can bring into their lives.

I would like to tell you of a vision that I have for congregations in our denomination to carry this work forward.

• I have a vision of congregations which include and address the needs of people with mental disorders to the best of their capability at every level of congregational life welcoming not only their presence, but the gifts of their lives as well.
• I have a vision of congregations which assume the presence of people with mental disorders, learn to support them, and, with their permission, include their stories in worship, religious education and other programs.
• I have a vision of congregations which encourage development of spiritual resources – exploration of a personal sense of truth and meaning in a place of safety and acceptance – to aid in caring for those with mental disorders and their families
• I have a vision of congregations which provide pastoral care for people with mental disorders and their families, as is done for people with other kinds of situations of need
• I have a vision of congregations which engage in outreach to those with mental disorders in its advertising and by actively supporting groups that address mental health, both secular and sacred.
• I have a vision of congregations which are aware of resources to address mental health issues in their community and provides referrals for people with mental disorders and their families
• I have a vision of congregations which attend to legislative developments and work to promote justice, freedom, and equality in the larger society.
• I have a vision of congregations which encourage and provide support groups for people with mental disorders and their families.
• I have a vision of congregations which speak out when the rights of people with mental disorders and their families are at stake.

Such congregations I would call Caring Congregations, and a religious denomination of such congregations I would call a Caring Religion. By living such a vision, we are following in the footsteps of Dorothea Dix, Benjamin Rush, and Joseph Workman.