Mental Health in America: Reflections from the Front Line reflections by David Hawkins, Licensed Counselor and Pastor
A Note from Jay McDaniel, editor of Open Horizons
There is a mental health crisis in America, hidden to some but not to others. For those of us interested in philosophy and theology, and also in “spirituality,” these issues can be hidden. We can write articulate and sometimes compelling essays on “how to be whole and live with integrity” without realizing that we are speaking from ignorance and arrogance: ignorance of the problems many people face and arrogance in thinking that our generalizations fit their situation. Our generalizations need to be grounded in reality, not in flights of fancy after a warm bath. I find myself wanting to talk with counselors and clergypersons on the front line. Recently I asked one of my former students, Rev. David Hawkins, to give me a reality check.
David is a Licensed Associate Counselor in a rural community mental health center in Arkansas. In this as in many other mental health settings, he has discovered a vast range of illnesses and adjustment problems for which people seek help. He is also an Ordained Elder in the United Methodist, having served as a pastor for 21 years in a variety of settings. He started his advanced psychological and counseling studies in large part because he found so many people coming to him as ‘pastor,’ dealing with issues which were as much, and sometimes more, mental/behavioral health problems than they were purely religious/spiritual issues. I asked him what three things he would like for people like me, middle class citizens for whom mental health problems are too often hidden, what three things he thought I should know. Here are his observations.
Mental Health in America Three Things to Keep in Mind
by David Hawkins: First, one of the greatest contributors to maladaptation is the state of living in crushing poverty. This type of poverty is both societal and institutionalized, while also very personal in the way it effects human lives. A thorough analysis of all the factors that go into creating environments of crushing poverty is beyond my scope, but I offer a few contributing factors that seem particularly salient. Living in an area where there simply are not available jobs that pay a living wage is a key feature of crushing poverty. Though we have a cultural penchant for overwork which may be unhealthy, to not be gainfully employed… to be idol... and often isolated… is not conducive to mental health. Under such pressure necessities like housing and food and clothing become dominant, and many of the higher aspirations of the human spirit become dormant. Maslow was right! Physiological needs are primary, and to live where these are in constant danger of not being provided for can be traumatic. Beyond these are security needs, the lack of which can also be traumatic, especially if one lives in a household or community riddled with violence. In our society, a modicum of income is the means by which these needs are initially provided. Where people can not make money legally, they will find other ways, one of which is by selling/manufacturing street drugs. The opioid addiction problem is serious, but the scourge of methamphetamines is in a close race for second place, and may be moving ahead in some geographic areas. For many others the quest for a meaningful and whole life is swallowed up in search for government or other assistance to meet basic needs. As one of our former Presidents once said, “It’s the economy stupid.” Without real development that effects both rural and inner city decay (education included), this aspect of the mental health crisis will continue as people, time after time, are stretched beyond their means of coping.
A second observation follows somewhat from the first, and that is the unimaginable presence of trauma in the life of many of those who ultimately struggle with mental health issues. We often think of our veterans who have experienced trauma in war, and a great many struggle with the effects of trauma in their life. Again, for the truly poor the constant struggle for food and shelter, especially for the children, is traumatic. But, such passive traumas are unfortunately compounded with actually witnessing and/or experiencing aggression and violence. From bullying at school to failed parental discipline, from domestic violence, to child/elder abuse and neglect, all the way to murder or finding bodies of the slain, trauma is everywhere! Trauma, especially prolonged trauma, may actually change actions in the brain’s neurochemistry such that healing from trauma once escaped may take some time. Trauma, like poverty, is a great equalizer in that neither respect a person’s race, gender, political affiliation, sexual-orientation or any other category of which I can think except one, socio-economic status. Not to be redundant, but it also happens to be the case that locations marked by poverty are also often marred by higher levels of violence and traumatic experiences than is usually experienced in areas of affluence. Yet, even affluence provides little protection from domestic forms of violence. It is impossible to avoid all adverse experiences in life, but it is time we took an honest look at how our culture of violence lays the foundation for trauma and how trauma is often at the foundation of mental health problems.
My third observation is a more positive note. The resilience and perseverance of many who face life’s challenges while also managing a mental illness is a source of great hope. It is manifold the ingenious and not so ingenious ways people cope with mental health problems more or less successfully. For many, Dr. prescribed psychotropics/medication helps the healing process. For others therapy and especially the therapeutic relationship can be a source of healing and coping. Some try to “self-medicate” with marijuana or other drugs, a strategy that often backfires. Where I live, church is still a source of community and solace for many. I believe there are better manifestations of “church” than others from a mental health perspective. Church’s/religious communities that focus on love, reconciliation, and acceptance seem to help more than those that focus on judgment, division and theological abstractions. It must also be noted that some forms of religious primitivism can be detrimental to mental health, such as when religious leaders tell people to get off their meds and command the demons away. A great many people who struggle with mental health issues have had such experiences and want nothing to do with “church.” Embodied care for others seems to be a key in assisting those with mental health problems, regardless of one’s secular or religious reasons for embodying that care. The amazing courage I have seen in abuse/trauma survivors is humbling. Some people can integrate their potentially life crushing experience into a new coherent personhood that is often filled with compassion and expectation for the future. The initial aim of life can be thwarted, it inevitably evolves as life unfolds, but it endures. Other people with potentially very severe illness compensate. “Sometimes you just have to make peace with the voices.” A great many of these victory stories are in part made possible by the persons, mostly women, who serve in many roles as community mental health workers.
The resilience I have observed brings me back to my theological interests. Though not usually stated in religious terms, the question at the heart of many people in crisis is, “Is there grace sufficient for today?” Philosophically I believe there is, but it is nice to see your philosophical/theological commitments occasionally become embodied in sustained and transformed lives. It would be good if such grace could find its way into some of our social and economic structures, so that such transformations could become more of the rule than the exception. There is a sustaining graciousness about this universe in which we live, but experience teaches that this grace needs to become embodied care for it to be made manifest in life. In facing the mental health crises before us, there needs to be plenty of room at the working table for persons of faith and persons of no-faith, therapists and clients, politicians and economists, and many others who seek the common good.
Looking squarely at this situation from the perspective of a clinician, open to collaboration with others for the mental health of our neighbors, I am reminded of the dictum by John Wesley which is crucial for religion, specifically Christianity, to remain a meaningful participant in the struggle for mental health. Paraphrasing Wesley, “There is no religion but social religion. No Gospel but the social Gospel.” An individualized, escapist, religiosity will be of little help to the seriously mentally ill. Yet, I hold out the hope of positive psychology that there may be a holistic, embodied spirituality that can be socially conducive to mental health and greater functioning.