Institutions, Care, and Better Conversations

Do we need more mental healthcare institutions?

A 1900s photo of St. Elizabeths Hospital in DC

This question has entered the national discussion after the horrific shooting in Parkland, Florida. I've written in far-too-great length (at least for a blog) about the problem with associating mass violence with mental illness -- here's Part I and Part II of "Mental Illness Isn't Violence (But Our Systems Sure Are Sick)." But the discussion around institutionalization is close to my heart -- my book, which will be released next month, largely revolves around my own experiences with psychiatric hospitalization -- and I thought it would be worth sharing a few quick points about it:

-- Deinstitutionalization began in the 60s and 70s as a response to civil rights and mental health advocates who spoke out against institutional abuse and neglect. The idea was to close big institutions, which were horrendous and often served not so much as health care centers as prisons for folks who didn't "fit," and replace them with community mental health centers. These centers would be smaller, more localized, and more integrated into communities, allowing for people with mental illnesses to remain connected to other sources of support such as families, faith communities, friends, and other community services.

-- During the 80s, community mental health centers fell victim to tax cuts and lack of funding. Rather than transitioning from big, awful institutions to smaller, community-based centers, we went from institutions to not much of anything at all. Many advocates trace the modern realities of homelessness in this country to this period.

-- Currently, there is a massive shortage of psychiatric beds in this country. According to a report by the Treatment Advocacy Center, in 2010 there were only about 14 beds available for every 100,000 people in this country.

An image from the Treatment Advocacy Center's "A Bed Instead" campaign

-- This shortage, among other factors, means that hospital emergency rooms, prisons, and homelessness have effectively taken the place of psychiatric hospitalization for many people experiencing serious mental illness.

-- Like everything else in this country, this reality is further impacted by racial and socioeconomic factors. Who gets a bed, and who ends up in prison, is affected by intersecting and oppressive systems.

-- We need more psychiatric beds, but not because mental illness is predictive of violence. As I've written about previously, those with mental illnesses are much more likely to be victims of violence in this country, and if we want to have conversations around the mental health implications of mass violence, we need to take a systems approach that considers factors such as toxic masculinity, white supremacy, cultures of violence, and access to guns.

-- We need more and better mental health care facilities, but this administration's rhetoric on the matter is stigmatizing, reactionary, and harmful. It ought to go without saying, but of course it doesn't these days, that saying we need more institutions to deal with "sickos" demonizes and scapegoats people with mental illnesses.

-- We need more and better care options for folks with mental illness because folks with mental illness are people who deserve care, compassion, and health. 

There is more to say on the matter from a policy perspective, but these are at least a few framing points for the conversation, centering it where it should be centered -- actual, effective, compassionate care -- rather than as a reactionary conversation that equates mental illness with violent crimes.

Let me wrap this up with a few words about my own experience with psychiatric hospitalization/institutionalization.

If you want more than a few words, I know where you can find them.

First of all, my experience was a privileged one. I had access to quality care, and to people who knew how to connect me to quality care, which are not realities that can be taken for granted by most people in the U.S. I also had a level of awareness of my own need for help, both because of conversations within my family about mental illness and also because of the nature of my illness. My racial identity, socioeconomic background, and other factors allowed me a level of access that is often denied to people in this country who are impacted by multiple oppressions. And still, in spite of all of this, psychiatric hospitalization felt scary, and isolating, and out of my control. I am very grateful for the hospitals that kept me safe and gave me space to stabilize and start on the path toward healing; and also, conversations around psychiatric hospitalization -- and even more so long-term institutionalization -- should be approached with a great deal of care, compassion, and nuance.

On a second, and related, note: we can't talk about "bringing institutions back" without acknowledging the fact that the prison system is standing in for an actual mental care system in this country. When I was discharged from a longer-term stay at a hospital in Connecticut, I returned to the DC area and began working with a therapy group using an approach called Dialectical Behavior Therapy. When I first met with the psychologist who ran the group, she shared with me that it was relatively rare for her to have men in her groups.

"Why is that?," I asked.

"Because men with your diagnoses usually end up in prison first," she said.

So if we're going to talk about the past abuses of institutions, we also need to be talking about the current abuses of our nation's de facto biggest mental health care institution -- the prison system -- not to mention the complete lack of institutional support faced by those experiencing homelessness. (I wrote more about this latter reality recently).

#EndTheStigma

Finally, my experience of hospitalization looked nothing like the popular perception of such a thing, which in my own pre-hospitalization experience was a mishmash of One Flew Over the Cuckoo's Nest-esque images of straitjackets and dictatorial nursing staff. You can read a whole heck of a lot more about my experience in my book (did I mention it's coming out next month?). Suffice to say I think it's really important that we de-stigmatize psychiatric hospitalization. It saved my life. At the same time, we need to acknowledge the history of institutional abuse and neglect and be very careful that our approach to mental healthcare institutions is focused on compassionate and effective care. Reactionary, stigmatizing rhetoric will not produce this.


Psychiatric hospitalization saved my life. It deserves to be talked about. We do need more, better mental health care institutions. And the importance of these institutions deserves a conversation focused on compassion, care, and effective treatment, not on blaming and scapegoating people with mental illnesses.

Spirituality and Solidarity ( a re-post because I don't have new words)

I originally shared this while I was working at American University, after a string of attacks around the world and bias incidents on campus. (You can see the archived original here.) I don't have any new words right now, for Las Vegas or for Puerto Rico or for Saint Louis or for Georgetown, so I'm posting it with some modifications. Some places you can take action: Moms Demand Action for Gun Sense ; ADAPT National ; Help Puerto Rico ; Campaign Zero

---

Dear friends,

My heart is heavy today. News of violent attacks and the devastation of climate disasters have left us in a state of shock and mourning. Here on campus at Georgetown, we are reeling from a string of racist, sexist, and anti-Semitic graffiti. This all just in the past week or two. Not to mention that we have yet to truly reckon with the trauma of Charlottesville, or yet another police officer acquitted for the shooting of an unarmed black man. Not to mention all of the many places in this world where hatred and division seem to be winning out over love and peace.

The news of tragedy mounts, and it can feel paralyzing. What can we do in the face of such violence? How can we respond?

Of course, we pray. We join together in prayer for all victims of violence and for all those mourning the dead. We pray for peace and for justice. We pray that God will stir up in us a concern for our common humanity and a love for neighbor, even a love for those who would declare themselves our enemies. We take a moment to intentionally extend our compassion to those in pain, even and especially because many of them are strangers to us.

But is this enough? Is it enough to pray, or is more called for?

In one sense, no — prayer is not enough. Action is needed. But in another sense — yes, prayer is enough. For Christians, the spirituality that we express in prayer is an orientation toward and a communion with Jesus Christ. And this Jesus to whom we pray is called Emmanuel, “God with us.” This Jesus stands in solidarity with all those who are victimized and oppressed, all those who are hurting and mourning, all those who are afflicted and sorely pressed. When we read the story of the Crucifixion, we are reminded that in Christ God stands in solidarity even with those feel forsaken or abandoned by God.

When we pray, we open ourselves up to the movement of the Spirit of Christ, which is always the Spirit of solidarity, of reconciliation, and of love in action. Prayer is an expression of solidarity that leads us into further action; and, conversely, our actions of solidarity and advocacy are expressions of prayer.

For those of you who have heard me pray aloud during a worship service, you might have heard me conclude prayers like this: “When we don’t know how to pray, God’s Spirit cries out within us in sighs too deep for words.” I didn’t invent this phrase — it’s just an adaptation of the words of the Apostle Paul, from his letter to the church in Rome: “Likewise, the Spirit helps us in our weakness; for we do not know how to pray as we ought, but that very Spirit intercedes with sighs too deep for words. And God, who searches the heart, knows what is the mind of the Spirit, because the Spirit intercedes for the saints according to the will of God.” (Romans 8:26-27, NRSV translation)

Just before these lines, Paul writes of hope in the midst of the suffering of creation: “We know that the whole creation has been groaning in labor pains until now; and not only the creation, but we ourselves, who have the first fruits of the Spirit, groan inwardly while we wait for adoption, the redemption of our bodies. For by hope we were saved. Now hope that is seen is not hope. For who hopes for what is seen? But if we hope for what we do not see, we wait for it with patience.” (Romans 8:22-25)

All creation is groaning with strife. This morning, this past week, this past month, we’ve heard those groans in a most loud and painful way. And in the face of division and tragedy, it is often difficult to know how to pray, much less what else can be done. Yet Paul links the groaning of creation in the midst of suffering with the groaning of our own hearts in prayer. When we join together in prayer for those who are hurting, we link ourselves to the cries of creation and find ourselves, there, in the heart of God. Prayer links us to Christ in solidarity with the groaning of creation.

Prayer is solidarity. And solidarity is prayer.

One of the central tasks of the Christian community is to proclaim good news — and it is difficult, sometimes seemingly impossible, to do so when faced with such a proliferation of tragic news. Yet I am reminded, today, of the Apostle Paul’s words — that in the midst of the suffering of creation, there is something being born, something being brought to life — the hoped-for redemption, not only of humanity, but of the cosmos.

And so we pray, and we act. In the words of pastor and hymn writer Fred Kaan: “For the healing of the nations, Lord, we pray with one accord; for a just and equal sharing of the things that earth affords; to a life in of love and action help us rise and pledge our word.”

May our prayers join together with the prayers of the world, with the groaning of creation, and lead us out into the world as a sign of solidarity and love in action. And as we go into the world, may we be reminded of Jesus’ promise to us, as written in the conclusion of Matthew’s gospel:

“Look, I myself will be with you every day until the end of this present age.”

Grace and peace be with us all.

A Palimpsest, My Arm (a post for National Suicide Prevention Week)

Content warning: this post discusses suicidal ideation and self-harm. 

National Suicide Prevention Week is observed in the U.S. through the week following or including September 10th, recognized as World Suicide Prevention Day. I had meant to write this post last week, but I was sick all week, so I guess this is something that needed to percolate.

If you or someone you know is suffering from suicidal thoughts or feelings, help is available. The National Suicide Prevention Hotline is available 24 hours a day: 1-800-273-8255. The hotline also has an online chat option. 

You are not alone. Your story isn't over.

---

My new tattoo: "My grace is sufficient for you;"

This summer, I got a tattoo on my left forearm.

I've been thinking about getting it for a long time. People who knew me while I was going through a particularly hard time a few years back might recognize the words. I used to write them on my arm in Sharpie marker, over and over again. For the past five years, by the grace of God, I haven't had to write them. But for those five years, I've thought about getting them tattooed over -- but not fully concealing -- the underlying scars, the criss-crossed white line reminders of hurt.

I put those scars there myself. I had run out of words, or so it seemed to me. So I cut and burned those scars onto myself because somehow, having that pain on my skin seemed better than having it locked up inside of me. Because somehow, if I was going to feel so hurt and jagged and cut-up inside, I wanted the outside of me to show it. I wished those cuts were deep enough to kill. But then I was ashamed, and hid my arms in hoodies in the anvil heat of D.C. summer.

One night, by some intervention of grace, I picked up a Sharpie instead of a blade. What I had intended to write on my arm was more shame, more anger. I intended to write, "You should be over this."And by that same gracious intervention, instead, I wrote a snippet of a Bible verse, a line remembered from a sermon in the hospital, from 2 Corinthians 12, verse 9: "My grace is sufficient for you," the apostle Paul recounts hearing from God, "for power is made perfect in weakness."

I dedicate a chapter in my book to this sufficiency, this enough-ness, in all of the many ways that it has wound its way through my heart and my mind and my soul as I have learned to live with mental illness. And after all these years I still need that reminder. The tattoo was a way to have my body be part of that reminder -- a reminder of enough-ness rather than a reminder of shame.

And now, my arm is a palimpsest.

Definition of "palimpsest" from Merriam-Webster

A palimpsest is parchment that has layers of writing on it, older layers having been erased to make room for new writing. But the erasure is never quite complete -- evidence of the old writing remains.

"My grace is sufficient for you;" my new tattoo reads. (The semicolon is a reference to Project Semicolon, whose founder, Amy Bleul, claimed it as a symbol of a sentence that could have ended but continued. The semicolon represents a story that is not over.)

It's written on my arm permanently, now, in much darker ink than the white scar tissue. But the scars are still there. That is part of the story, too. The new story contains the old story. We cannot erase the past, only write new words, new sentences, over and in and through the older layers of our lives.

My arm is a palimpsest, as is my life, as is our world, layer upon layer of story that cannot ever be completely erased or covered over. Evidence of the old words remain.

But. I couldn't have gotten this tattoo five years ago. I couldn't have done this, safely, if the wounds were still fresh -- certainly not if the wounds were still being inflicted.

And that matters, because as a country, it often feels as if we are not only trying to erase the past, rather than writing a new story over the still-visible scars of the old, but that we are trying to write a new story while still self-inflicting the very repetitive wounds that we are attempt to deny.

Just as one example: this week, here at Georgetown, we (chaplains and other campus voices) have been responding to what the University refers to as a "bias-related incident." Specifically, multiple cases of swastikas, with accompanying writing about violence against women, being painted in a residence hall bathroom right at the beginning of the Jewish High Holy Days.

I would like this to be in the past. I would like for the swastika-shaped scars to be faded and white and ready to be permanently written over with new words. But they are fresh, and red, and hurting, and that means a different type of response is needed. The wounds of white supremacism, of racism, of antisemitism, of sexism, keep being re-inflicted. I want to scream at them, "I thought you were over this!" To end them with shame and fierce ridicule. But we are not over this. We are not. And perhaps there is still a different, more honestly and graciously true story to be written of us.

So we respond to the wounds, and we try to take away the weaponry, the blades, and we write tentative new stories, with soft markers, and it all seems like not enough, like such a paltry response to such harsh and repetitive wounding.

"My grace is sufficient for you," I wrote, over and over and over again. Sometimes it was enough to keep me from hurting myself. Sometimes it wasn't.

But it was a breaking-in of something that at the time seemed so foreign to me, so impossible. Some tentative hope. Some mysterious enough-ness that I could only begin to appropriate and internalize.

Some kind of grace.

My arm is a palimpsest now, so that when I look at it, I first read the grace and the enough-ness, before I encounter the old scars.

And encounter I must. They are a part of me, a part of my story. But they are not all of me. They are not all of my story. And they are certainly not the period at the end of my story.

And so we begin, tentatively, uncertainly, armed with markers against the blades:

to write new stories of grace.

--

Thank you for reading about a difficult topic. If you appreciated this post, you might check out my upcoming book, Christ on the Psych Ward, which expands on many of these themes and is now available for pre-order at churchpublishing.org or amazon.com.  And if you're in the DC area, you can come here me read a bit from it and chat about it this coming Wednesday.

Also, here's a helpful recent article from Mental Health First Aid USA about the differences between suicidal ideation and self-injury. 

It's ok to get 'distracted' by other people's pain

"Don't get distracted!"

I keep seeing posts with this dire warning popping up in my social media feeds. Whatever you're currently paying attention to, these posts assert, is the wrong thing to be paying attention to. It's a distraction, a carefully planned ploy to cover up some other form of foul play. You need to focus on the *real* issue here, which is...well, whatever the person posting has decided, for that day, is the real issue, I suppose.

Of course, social media being what it is, there is a tendency to get caught up in a sort of "outrage of the moment" mentality, which perhaps doesn't lend itself well to the sort of consistent work that bears justice fruit. On the other hand, humans are, in fact, capable of caring about more than one thing at once.

But what's been bothering me about these posts lately is that they seem to me to essentially be criticisms of empathy. The term "distraction" is used to dismiss a reaction to the pain of others.

And I just think it's ok to get "distracted" by other people's pain.

The post that finally made me roll my (literal) eyes, roll up my (figurative) sleeves, and write this (uh...digital?) blog post was an assertion that people reacting to the Senate continuing debate on health care without an actual health care bill on the table were getting distracted from the "real" issue, which apparently had to do with consumer protections being voted on by the House.

But of course, for me, the Affordable Care Act isn't a "distraction" -- it's the difference between me being able to access care for my mental illness, and me not being able to do so. But if you're not someone who has to rely on the ACA for health insurance, I suppose it's easy to view it as a "distraction" from the "real" issue.

It's easy for cisgender folks to see tweets from the President demonizing and vilifying transgender folks as a "distraction." It's easy for me, who never really fit in as a Cub Scout and never made it past Weeblos, to see some news item about the Boy Scouts as a distraction.

It's easy to dismiss other people's pain. But what I want, what I hope for, what I pray for the grace and strength to work for, is a more empathetic world, more empathetic communities, where we do not so easily dismiss each other's pain.

I once heard the Rev. Traci Blackmon, who serves as Executive Minister of Justice & Wellness Ministries for the United Church of Christ, give a sermon at the Wild Goose Festival. She preached on John 9. I'll never forget one line from her sermon: "Oh, how I wish we could be more like Jesus," she said, "who never debated people's pain in the third person."

What I would like to see is a more empathetic world. A world in which we do not "debate people's pain in the third person." And in that world, it is ok -- in fact, it is required -- to allow ourselves to be distracted by each other's pain.

I very much doubt that we are the victims of some sort of mastermind distraction plot crafted by a band of media savvy goons. Plain old meanness and lack of empathy, in a system already designed to shore up existent power relations, will do nicely as an explanatory framework, I think. And if I'm right about that, then we need not spend our time lambasting the attention paid to the latest meanness, the latest use of violent language to shore up violent power.

In such a system as this, which thrives off of divisions and isolation, it is good and right to allow ourselves to be distracted by people's pain.

Grace is a Preexisting Condition

I don't want to write about Congress.

I don't to write about this latest horror show of a bill, a bill I won't call a "healthcare bill" because it is whatever the opposite of that is, a bill about not caring about people's health.

I don't want to write about the group of white men who just blithely voted to threaten my health coverage, while making sure to keep their own (taxpayer-funded, government-provided) coverage.

I don't want to write about the stunning hypocrisy -- frankly, that's too generous of a word, as hypocrisy requires some sort of consistently expressed set of values to violate -- of a party that's run on the image of "traditional family values," yet is just fine with defining sexual assault and domestic violence and postpartum depression as "preexisting conditions."

I don't want to write about any of that. It makes me sick, and other, more politically savvy people have already put out plenty of analysis.

What I want to write about is grace.

In 2011, when a doctor first told me that the awful experience I was having might be a mental illness, the diagnosis came as a relief. I am a person of words, a person whose purpose, whose vocation, has always been caught up in a love of words. I write stories, I sing songs, I preach sermons, I love theology -- theo logos, words about God. To hurt without words was, is, terrifying for me. Some people hate the label of a mental illness diagnosis, and I understand the resistance to a simple, narrow label. But me, I was relieved to have words.

There was, I know now, a naivete to my relief. I didn't know, then, that bipolar disorder constituted a "preexisting condition" which would allow insurance companies to categorically deny my applications for coverage. Over and over again.

Or don't, I'm getting bored with it. 

Of course, my prior indifference to this reality was privilege, plain and simple. The maladies considered to be "preexisting conditions" were -- and are again -- Legion, and innumerable are those possessed of them. I was shielded from this particular thorn in the side until my mid-twenties; most Americans are not so lucky.

I had a brief respite from this under the Affordable Care Act -- which, simultaneously, expanded Medicaid enough so that I was eligible for coverage under it while still a student -- but Congressional Republicans, apparently lacking any real guiding set of values, any real compassion, and secure in their own tax-payer funded, government-provided health care coverage, could not let such a thing stand.

But I don't want to write about that.

I want to write about grace.

Grace is the welcoming, the reconciling, the transforming love of God.

Grace is a preexisting condition.

Grace is prior to what we do and what we say.

Before bipolar disorder. Before words -- words about politics, words about mental illness, words about me. Before me. Grace is.

Grace creates us, grace forms us, grace breathes life into us. Grace is the original intention, the creative and unitive force, that goes before...everything.

We are breathed, formed, by grace. Nothing to be done about that. But what we can do, what we are in fact quite stunningly capable of doing, is getting in the way of grace, restricting and blocking the channels by which divine love flows in and through us.

Here's some ways to do that:

We can refuse to listen to people who are sick and suffering, people struggling with cancer and with mental illness and with diabetes. That is a way to block grace.

We can refuse to listen to the stories of those who have been sexually assaulted, raped, abused. That is a way to block grace.

We can shut down our inherent capacity for empathy and connection, can see people as problems to be solved, sickness as personal failure, suffering as moral inferiority. That is a way to block grace.

But people are not problems. Sickness is not failure. Suffering is not immorality.

When we cut off grace -- when we purposely block the preexisting rhythms of creation and compassion -- that is a problem. That is a failure. That is immorality.

That is sin.

Grace is a preexisting condition. Choosing to hurt people, to reject people's story, to refuse care for people -- that's a choice. That's us. We do that.

But we don't have to. We could make different choices. We were made for love, for empathy, for connection, for the sharing of stories. That's what we were intended for.

Because grace came first.

Perhaps Congress should remember that. Perhaps they should remember that their actions will be weighed on a cosmic scale. But my faith isn't in Congress, that is for damn sure.

In the beginning, before words, there was the Word, and the Word was Love. Grace is a preexisting condition.

--

If you found this post to be helpful, or inspiring, or interesting, then you might want to know that I'm working on a book that touches on a lot of these themes. It's called Christ on the Psych Ward, and you can find out more about it and pre-order it by visiting this page.