Brain research may be the greatest scientific adventure of our time, but it has had no practical payoff for the mentally ill. We have learned fantastic things about what makes us tick, but none of the findings has helped a single patient.
The National Institute of Mental Health is betting billions of dollars that useful answers are just around the scientific corner. My guess is that if there were low-hanging fruit, we would already be picking it.
Progress in understanding and treating mental disorders will be slow and piecemeal. Don't hold your breath waiting for breakthroughs. With its 100 trillion connections, the human brain is the most complicated contraption in the universe. Things can go wrong in lots of different ways. The more we learn about mental disorders, the further we seem from really understanding them.
The fascination with brain research has in fact been paradoxically bad for patients. Its future promise distracts attention from their pressing current needs. Vast amounts of money, time, and talent are devoted to the high-tech stuff, while the simple things that would make patients' lives livable are terribly shortchanged. We could, but don't, provide a decent place to live, caring people to live with, and easy access to treatment.
The rest of the civilized world does a much better job of caring for the mentally ill. Some places -- Italy and Scandinavia -- do an especially great job. The U.S. is a disgraceful laggard, with hundreds of thousands of mentally ill in prison and hundreds of thousands homeless.
We don't need more research into what to do. We just need to have the heart, will, and funds to do it.
Virgil Stucker has been living with and for the severely mentally ill all his adult life. Perhaps better than anyone, he can tell us what works. Virgil was the founding chairman and president of the Foundation for Excellence in Mental Health Care and is currently the founding executive director and president of CooperRiis Healing Community. He writes:
Too often, we have thought that only "rocket scientists" could understand the vagaries of the mind, heart, brain, and soul. We need the scientists, but, first and most; we need people who understand the healing power of relationships and engagement in community.
For forty years, my wife Lis and I have lived in four different therapeutic communities, where we raised our children and host our grandchildren. Our youngsters grew up among the residents (diagnosed with schizophrenia, bipolar disorder and depression) who ate at our table and shared in our lives.
I am reminded of a meal when our young Christoph was puzzled about his friend Ed at the end of the table who was wearing his depression with head down. Christoph crawled under the table, looked up into Ed's eyes with a chuckle and Ed soon lost his depression.
I remember another time when Christoph wandered too close to the river and fell in. One of the residents jumped in and saved his life.
Now that they are adults, Christoph and his sister Stephanie continue to work with us in our CooperRiis community. Our Heidi is solving food system problems in Massachusetts and our son Dominic works worldwide on climate change issues. Our seven grandchildren also now sit some days at the table in our community.
It has been my life's passion to help the victims of mental illness discover that they can again be loveable, loving, purposeful people with the ability no longer to be overwhelmed by their illness.
The nonprofit therapeutic communities I led provide college-like experiences where recovery and community reintegration skills and resilience are learned.
Therapeutic communities provide residents with a home (not housing), purposeful work, and myriad meaningful relationships. Each resident awakens into a world that needs them, either in the organic gardens, in the barns with the animals, in the woodshop making flutes and drums, in the kitchen preparing holistic meals or keeping the campus in order. In our urban setting without a farm, outside community service opportunities abound. Recreational, artistic and exercise options fill out the rest of the day.
The structure of the day is peppered with individual and group sessions with one's psychiatrist, psychotherapist, social worker, nutritionist, neuro-feedback specialist, and exercise coach.
One's day, however, is not about awakening into a world that focuses on pathology; the focus is on awakening each resident's passion for life.
After about 6 to 9 months in the core therapeutic community setting, residents reintegrate with work and or education by moving through a continuum of community homes with staff support at each level to help them add resilience to the new skills they have learned.
The environment is safe, kind, appreciative, authentic, welcoming, compassionate and empathetic. Therapeutic communities are special places for people... who should feel special... not stigmatized and isolated.
Medication and treatment with professionals are often crucial in suppressing symptoms, but do not by themselves help the person to move into a sustainable condition of mental wellness.
Neither can crisis be reduced to a chemical imbalance or a brain defect. As humans, we want to love and be loved and to make a positive difference in the world of which we are a part.
In each therapeutic community we were also joined by philanthropists. The Founders of our CooperRiis Healing Communities are Don and Lisbeth Riis Cooper, who know acutely the pain of having a family member with a mental health condition. They say, "The most important thing we have done in life has been to start CooperRiis." Their donations have helped over 800 families in the last 11 years.
Each of our nearly 200 current staff also came to CooperRiis on a mission. And our more 100 residents come to us with hope for a life with a restored mission. Their Dream Statement is that more than their Diagnosis guides their Destiny.
Our country needs more therapeutic communities like CooperRiis. Other families like the Coopers could help to establish them with capital donations. Service fees from families, medical insurance, and scholarship donations can then cover the operating expenses.
It has been my family's great privilege to share our lives with individuals who have been diagnosed with serious mental illness. My hope is that my words about our involvement in therapeutic communities will inspire some readers to join this mission in whatever way makes sense for them. I also have a vision for how the concepts of therapeutic community might help existing community and religious groups to reach out to provide advocacy and help for the mentally ill. Compassionate community outreach should be the launching pad for healing.
The virtues of therapeutic or healing community could also be infused into our current mental health system, from state and private hospitals to community mental health centers. Perhaps even in prisons, which unfortunately are now the major de facto mental health centers. Consider as well our congregations; they could all become healing communities by reaching out and including the mentally ill. Also our voluntary associations like Kiwanis and Rotary.
We are failing as a civilization, because we have turned our backs on our most vulnerable. It's time to turn around and embrace these individuals who should feel special, not stigmatized.
Dehumanizing coercion tactics do not work; compassion does. Begin a conversation. Ask an obvious victim, "Are you OK?"... and, then, listen. Your natural ability to be compassionate will guide you.
Thanks, Virgil. You are an inspiration to me and I hope to many others.
The modern, common-sense, compassionate approach to mental illness began with Pinel 200 years ago and was based on the simple but powerful idea of therapeutic community. When I was beginning my psychiatric training 50 years ago, the model I was taught was therapeutic community. As Aristotle noted long ago, man is a social animal, and only in a social unit can he experience a whole life.
Mental illness often interferes with a person's easy and spontaneous participation in a social unit. A therapeutic community heals hurts and teaches new social skills. It takes a community to help a patient.
The shame of our time is that states have robbed mental health budgets to build and man prisons, a crazy and cruel mistake. Therapeutic communities are lots cheaper. Therapeutic communities are lots more compassionate. And therapeutic communities help people contribute to society rather than being outcast from it.
Advocacy for the mentally ill has been so ineffective in part because it has been so split in the often bitter civil war between the medical model and the recovery model. Virgil's life and work exemplify how dumb and destructive this is. There is an obvious need and room in the therapeutic community for the integration of both models. Neither works well without the other.
Let's hope many people find a way of their own to join Virgil in his life's work. We need to end the neglect and banishment of the mentally ill and instead restore them to useful participation in our communities. Other countries do it. We have no excuse.
Allen Frances is a professor emeritus at Duke University and was the chairman of the DSM-IV task force.