Day 7: Jackie Goldstein on Communities of Care
The future of mental health interview series, day 7
Posted Jan 24, 2016
The following interview is part of a “future of mental health” interview series that will be running for 100+ days. This series presents different points of view about what helps a person in distress. I’ve aimed to be ecumenical and included many points of view different from my own. I hope you enjoy it. As with every service and resource in the mental health field, please do your due diligence. If you’d like to learn more about these philosophies, services, and organizations mentioned, follow the links provided.
Interview with Jackie Goldstein
I’m very interested in the idea of “communities of care” and also in their reality: in those residential facilities, urban outposts, working farms, and occasionally entire towns and communities that treat individuals in emotional and mental distress with compassion and dignity. Jackie Goldstein is an expert in this area, having focused her research on the grandfather of these “communities of care,” the community of Geel in Belgium, and having visited countless “community of cares” throughout the United States.
EM: You are very interested in alternate approaches to mental health care different from the dominant model of one-to-one “diagnosing and treating.” Can you tell us a little bit about these alternative approaches?
JG: When I began to visit mental health programs in this country, to a large degree I sought out programs based on their reputation. In every case the reputation was well deserved to the extent that they provided opportunities for community integration and support. However, as I learned more about the background (history) and evolution of each program, I became aware of the fact that they were each developed using the unique resources of their own community in order to serve the needs of those with mental illness in the context of that community. In other words, there were common elements in these programs but there was not a one-size-fits-all approach. In addition, as they saw what was working in their own community there was flexibility in the continued evolution of the program.
EM: You’ve taken a special interest in the Belgian town of Geel. What’s the historical importance of Geel and what can we learn from its story?
JG: Geel’s history began with the “story” of a young Irish princess’s martyrdom in the face of her father’s mad, incestuous demands. The story of her martyrdom spread and eventually led to her sainthood as the patron saint of mental disorders. And, when the church was the place to go for “treatment,” Geel attracted hundreds, even thousands, of pilgrims, many of whom became boarders in the homes of community members (foster families). Out of necessity, Geel used their “resources” – an agrarian community with families willing to take on boarders who participated in family work. The custom endured and evolved over the centuries, resulting in a modern stigma-free community. Any community is wise to access and use their available resources to meet the needs of their community. Geel provides evidence that it is possible and desirable for those with a diagnosis of mental illness to live as accepted, active participating members of their community.
EM: You’ve traveled to many “communities of care” to observe what goes on in them. What are your headline findings or thoughts from those trips?
JG: The “boarders” of Geel were given the opportunity to do meaningful work. By today’s standards there would probably have to be regulations to guarantee that those with a diagnosis of mental illness would not be “required” to do work in exchange for treatment. Their rights would be protected, but no work means no meaningful work, no sense of purpose – in their life or in the community – and we must be careful to not “throw out the baby with the bath water.”
In 1812, Benjamin Rush, a founding father of our country and the founding father of psychiatry, wrote: “It has been remarked, that the maniacs of the male sex in all hospitals, who assist in cutting wood, making fires, and digging in a garden, and the females who are employed in washing, ironing, and scrubbing floors, often recover, while persons, whose rank exempts them from performing such services, languish away their lives within the walls of the hospital.”
The sites that I visited did provide clients with opportunities to perform meaningful work and, through that work, to become active members of community life. Often there are limitations on the kind of work that can be performed, but in some cases, if unable to meet the demands of a full or even part-time job, they will do volunteer work within their community.
EM: Does one community of care that you’ve visited stand out to you? What was particularly interesting about it?
JG: Different communities stand out for different reasons. I visited two residential treatment communities that function as working farms, offering residents the kind of meaningful work opportunities described above, as well as community interaction, i.e., the residential community in which they live. However, these are not inexpensive and involve long term treatment – to prepare the resident for a return to the larger community.
In a different vein, Broadway Community Housing (BCH) in NYC was founded by Ellen Baxter who, after graduating from college, received a fellowship to study in Geel for a year. She successfully brought what she learned in Geel to an urban setting. The first community housing facility opened in 1989 and there are currently seven such communities. In addition to a home, these communities provide useful services and these services are also offered to those who live in the neighborhood, but who have not been diagnosed with a mental disorder – a beautiful and successful variation of community integration.
EM: If you had a loved one in emotional or mental distress, what would you suggest that he or she do or try?
JG: The starting place must always be to seek professional help and evaluation. “Mental illness” is not a single “illness.” Diagnosis, and thus treatment, cannot be made through the use of a blood test or an imaging technique. The focus is on “symptoms” which can inform a diagnosis (necessary for insurance purposes). Due to the stigma of mental illness, individuals and their family members are often in denial, experiencing self-stigma. Thus, even as one is working with a mental health professional, family members can combat their stigma-driven fear through the kind of education that introduces them – directly or through reading – to others who have walked the same rocky path.
There are many good books written by either those who have been diagnosed or a family member. The details of their stories may not be exactly the same as yours, but the initial fear and frustration normally exists in all cases. It can also be useful to find out if National Alliance on Mental Illness (NAMI) meets in your community. In existence since 1979, NAMI “educates, advocates, listens, and leads.” There are hundreds of local affiliates, state organizations and volunteers who work in communities to raise awareness and provide support and education.
Jackie Goldstein, PhD, has her doctorate in behavioral neuroscience and retired in 2015 from her post as professor of psychology at Samford University, Birmingham, AL. Her new book, Voices of Hope for Mental Illness: Not Against, With, which describes Geel and other communities of care worldwide, appears in 2016.
Eric Maisel, Ph.D., is the author of 40+ books, among them The Future of Mental Health, Rethinking Depression, Mastering Creative Anxiety, Life Purpose Boot Camp and The Van Gogh Blues. Write Dr. Maisel at firstname.lastname@example.org, visit him at http://www.ericmaisel.com, and learn more about the future of mental health movement at http://www.thefutureofmentalhealth.com
To learn more about and/or to purchase The Future of Mental Health: Deconstructing the Mental Disorder Paradigm visit here.
To see the complete roster of interview guests, please visit here: