The Mental Health Ministry of the Local Church by Howard J. Clinebell, Jr.
Howard J. Clinebell, Jr. Is Professor of Pastoral Counseling at the School of Theology at Claremont, California (1977). He is a member of the American Association of Marriage and Family Counselors, and the American Association of Pastoral Counselors. He is a licensed marriage, child and family counselor in the State of California. His personal website is http://members.aol.com/clinebellh/index.htm, and his email address is clinebellH@aol.com. Originally published as Mental Health Through Christian Community Copyright © 1965,1972 by Abingdon Press Apex Edition published 1972. This material was prepared for Religion Online by Ted and Winnie Brock.
Chapter 5: The Prophetic Ministry and Mental Health
We are moving toward the close of the 20th century with a religious community largely adjusted to the status quo -- taillight behind other community agencies rather than a head light leading men to higher levels of justice....
There was a time when the church was very powerful . . . the early Christians rejoiced at being deemed worthy to suffer for what they believed. In those days the Church was not merely a thermometer that recorded the ideas and principles of popular opinion; it was a thermostat that transformed the mores of society. Whenever the early Christians entered a town the power structure got disturbed and immediately sought to convict them for being "disturbers of the peace" and "outside agitators." But the Christians pressed on, in the conviction that they were "a colony of heaven," called to obey God rather than man. Small in number, they were big in commitment . . . they brought an end to such ancient evils as infanticide and gladiatorial contest....
Things are different now. So often the contemporary church is a weak, ineffectual voice with an uncertain sound. So often it is the archdefender of the status quo. Far from being disturbed by the presence of the church, the power structure of the average community is consoled by the church's silent -- and often even vocal -- sanction of things as they are.("Letter from Birmingham Jail," Christian Century, LXXX (June 12, 1963), 772.)
-- Martin Luther King, Jr.
The Nature of the Prophetic Ministry
What does a church's concern for a just society and a warless world have to do with mental health? Everything! The prophetic ministry constitutes an essential part of any church's mental health opportunity. A dynamic concern for the problems of individuals should not cause a neglect of the social matrix which spawns individual problems. A church should work "like a miner under a landslide" to eliminate the social causes of mental illness and to create a growth-enhancing society in which positive mental health will bloom like a rose.
It is a church's business to be a leavening influence in its community -- to work as well as pray, for the kingdom's coming "on earth as it is heaven." Its "community" is composed of concentric circles which eventually widen to include the world community. John Wesley's familiar words, "The world is my parish," have a breathless urgency in our day when no point on the planet is more than one-half hour from ICBM obliteration. A church's prophetic ministry is a contemporary expression of the passion for social justice of the Old Testament prophets. It reflects the spirit of Jesus' cleansing of the temple -- an incident in which he "disturbed the peace" in challenging an exploitative system. The prophetic ministry is a vital part of "diakonia," the New Testament word for the church's ministry to the community, through which it becomes the continuing incarnation of Christ in the world. This ministry is as much the responsibility of laymen as of clergymen. In fact, since the layman is often in a strategic position to implement a "marketplace ministry," his prophetic opportunity frequently surpasses that of the clergyman.
The Interdependence of Individual and Social Problems
There are various handy escape routes available for avoiding one's Christian responsibility to change institutionalized forms of evil. One is the other-worldly thrust of some contemporary theologies which affirm a radical discontinuity between this world and God's kingdom. Such theologies cut the nerve of social concern,and action. Fortunately, their influence on American ministers has been relatively small and even less on laymen. A more popular escape route consists of a lopsided emphasis on helping individuals. This general route has several alternates. The revivalist road is one of these with its one-sided emphasis on the salvation of individuals. Interestingly enough, an alternate of this same route is the one followed by some who are so overly invested in pastoral counseling and/or spiritual healing as to virtually ignore social problems. This is a revival of individualistic pietism in psychological garb. From a mental health perspective, it is shortsighted and out of balance.
A church should have a balanced concern for both the individual roots of social problems and the social roots of individual problems. Obviously it is essential to work simultaneously on both ends of the human situation.
The circular relationship between individual and social problems becomes increasingly clear as the research findings of the behavioral scientists accumulate. A study was made of the outlook and attitudes of persons living in two middle income housing projects. The only major difference between the two projects was that one was integrated and the other was not. It was found that Negroes living in the racially integrated facility showed a more positive attitude toward life and seemed better adjusted in. general than those in the nonintegrated housing.( Social Action in Review (May-June. 1957). Published by the Commission on Social Action of the Union of American Hebrew Congregations.) Segregation per se has a damaging effect on the self-esteem and therefore the mental health of those segregated. A psychiatrist who studied the effects of the school desegregation conflict on children in the Deep South reports: "I have been struck by how clearly young Negro children foresee the bleak future of their lives. With crayons, a medium of quiet eloquence . . . they draw a world of fear and foreboding, of worthlessness, of anticipated uselessness." (Robert Coles, "Racial Identity in School Children," The Saturday Review (October 19, 1963), p. 57. See also M. M. Grossack (ed.) Mental Health and Segregation (New York: Springer Publishing Co., 1963). All of his young Negro subjects expressed intense feelings of loneliness and vulnerability.
Studies by social psychiatrists emphasize the role played by environmental pressures on the development of personality illnesses. Slum areas subject those who are trapped there (usually because they are members of a ghettoed minority group) to severe stresses which erode their self-esteem and spawn all manner of social problems. Try to imagine, for instance, the interpersonal friction and lack of privacy which results from cramming two parents and six children into one, cockroach-infested room with a primitive kitchen and a toilet shared with three other families.
Recent studies have discovered that the poor are much more vulnerable to the severe forms of mental illness, than are middle class groups. Thomas S. Langner and Stanley T. Michael, in a monumental study of midtown Manhattan residents, found that socioeconomic status is more closely associated with rates of mental illness, than any other demographic factor. (See Life Stress and Mental Illness. New York: Basic Books, 1963.) The increased vulnerability was found not to be simply the result of greater stresses on security and self-esteem (e.g. broken homes, poor health, job insecurity). Lower class persons with the same number of stress factors as middle class counterparts develop more personality illness. A major reason for this is the fact that chronically impoverished persons respond to stress in ways that tend to be ineffective, leading to increased psychiatric impairment. For example, many become passive, depressed and withdrawn, thus moving away from the very qualities (initiative and imagination, for instance) which would allow them to take advantage of chance opportunities to improve their lot. Having tasted the bitter dregs of repeated failure, planning ahead and working for a better future (typical middle-class responses) seem utterly futile to them.
Some poverty-crippled persons respond to painful frustrations with anti-social behavior which starts a negative chain reaction with the law. The underprivileged respond to stress by moving toward alcoholism, drug addiction, and with schizophrenic and paranoid ways of relieving the stress, far more often than do those who are undergirded with middle-class securities. The tragedy of all this is compounded by the fact that most community mental health facilities are oriented to middle-class goals, vocabularies, patterns of problem solving and models of healing. Traditional introspective psycho-therapy is ineffective with the vast majority of persons from the impoverished classes. Fortunately, several experimental programs in psychiatry are gradually developing action-oriented alternatives which have therapeutic promise for such groups. For example. informal therapy groups in which members take active roles in helping each other handle concrete problems in living, seem to be more effective. Obviously, the alleviation of our country's huge "pockets of poverty" is an essential means of preventing a vast amount of mental illness.( I am indebted in this discussion to an illuminating article on the special mental health needs of the underprivileged by Dale White -- "Mental Health and the Poor," Concern, October 15, 1964, pp. 4-7. For a study of factors involved in social disintegration and their negative impact on mental health, see People of Cove and Woodlot, by Charles C. Hughcs et al (New York: Basic Books, Inc, 1960).
A dedicated psychotherapist who had spent his professional life treating sick individuals observed this sobering fact: "We therapists are treating disturbed persons on a retail basis while our society is creating personality disturbances in wholesale fashion." The late Japanese Christian leader, Kagawa, once used a figure of speech which aptly applies to any church which ignores social problems: It is maintaining a rescue station at the bottom of a cliff to help those who have fallen while neglecting to work at the top to keep others from falling.
Social Factors Which Contribute to Mental Ill Health
A Los Angeles news commentator, after scanning the Monday morning headlines of mayhem and chaos, began his newscast with the phrase: "This is what happened over the weekend in this craziest of all possible worlds." Any condition of social injustice, economic deprivation, political tyranny, or racial discrimination has a deleterious effect on the self-esteem of the victims. Anything that raises the anxiety level or lowers the self-esteem of parents diminishes their ability to be sensitive and responsive to the heart-hungers of their children.
Among the many social problems our society faces, three problems stand like volcanoes threatening to engulf our society -- thermonuclear war, racial injustice, and the population explosion. The impact of this terrible trio on mental health defies imagination.
Near the close of 1962, Aldous Huxley added some grim variations on his "Brave New World" theme. He predicted that the next decade will produce a situation in which one-third of the world, with its military-oriented, highly developed technology, will perpetually "descend into the steel and concrete dungeons of total civil defense." (Los Angeles Times (December 1,1962), p. 8.) The other two-thirds will be caught in the population explosion producing extreme hunger, poverty, social unrest, and the constant danger of totalitarian political control.
The psychological destruction that has resulted from recent wars and their aftermath of disease, famine, and hopelessness is well known. Now the world lives under the dark, malignant cloud of World War III that will, if it comes, make the others seem puny by comparison. Commenting on the threat of a thermo-nuclear holocaust, Stuart Chase writes:
Military experts can discuss "first strike," "second strike," and "counter-strike-with bonus"; but beyond these semantic exercises, it is obvious to the careful inquirer that both the U.S. and the USSR are now equipped to eliminate each other as viable societies by exploding a few large hydrogen bombs high in the stratosphere, generating firestorms of meteorological dimensions. These can incinerate every combustible object, natural or man-made, over vast areas, including occupants of all but the deepest oxygen-equipped shelters.( "Bombs, Babies, and Bulldozers," The Saturday Review (January 26, 1960, p. 22.)
The psychological and social problems created by the "baby A-bombs" dropped on Japan are minor compared to the aftermath of a hydrogen Armageddon with an estimated 93 million Americans and at least that many Russians destroyed and much of the earth poisoned by radioactivity. Unimaginative people, he holds, will continue to "hope for the best," taking refuge in what psychologists term "denial of reality." Chase continues: "People with reflective minds know that when the button is pushed, accidentally or otherwise, the country they love will, in a matter of minutes, cease to exist as a going concern. The fact that the enemy also ceases to exist is scant consolation. Our freedom will be buried in the same trench with his tyrannies."( Ibid.)
Nightmare thermonuclear weapons are poised in underground ICBM silos on both sides of the cold war. In the light of this, the game of prenuclear age power politics which the leaders of nations continue to play is preposterous, suicidal nonsense. The nuclear sword of Damocles which hangs over our civilization is, even for the semi-aware, a realistic source of constant anxieties of major proportions. Let me emphasize that we should feel anxious and should be motivated by this anxiety to change the situation. The salutary effects on the mental health of mankind would be beyond estimate if this horrible cloud could be removed through the achievement of permanent nuclear disarmament and an international police force under a strengthened United Nations
The circular relationship between social and psychological problems is well-illustrated by the peace issue. We will not have stable peace unless we are able to master some of the gigantic inner problems of man -- his pent-up rage, his fears, his "escape from freedom" into authoritarian systems, his over-identification with nationalistic groups. Psychiatrists William C. Menninger and Jerome Frank have both pointed out that the behavior among nations displays many of the symptoms of psychologically sick individuals paranoid mistrust, tension, pettiness, extreme self-centeredness, and the need to see one's enemies as all bad and oneself as all good. In an address entitled "The Psychiatry of Enduring Peace and Social Progress," psychiatrist Brock Chisholm, Director-General of WHO, from 1948-1953 declared: "So far in the history of the world there have never been enough mature people in the right places." (Psychiatry, Vol. 9, No. I (February, 1946). p. 6.)
Fifteen years ago a group of psychiatrists. including Harry Stack Sullivan, Daniel T. Bain, and George S. Stevenson, made this significant statement in a preparatory report from the International Congress on Mental Health:
Principles of mental health cannot be successfully furthered in any society unless there is progressive acceptance of the concept of world citizenship. World citizenship can be widely extended among all people through the application of the principles of mental health . . . the problem of world citizenship in relation to human survival needs to be formulated afresh in the light of new knowledge about aggressiveness in man, group tensions and resentments, race prejudices and nationalist sentiments and stereotypes.( Preparatory Report (London: International Congress on Mental Health, 1948).
Knowledge from the sciences of man can help us achieve world citizenship, which, in turn will contribute mightily, to mental health. We in the church need a spirit like that of John Wesley who, in a sermon on the Beatitudes described the man of love as a "citizen of the world." This is our first loyalty as Christians!
The real threat to man's existence is not the A, H, or C bombs, but man. The unique factor about the present situation is that the vast human potentiality for destructiveness (in blocked creativity) is now armed with fiendish instruments of mass annihilation. This makes it imperative that we learn to understand and control the destructive forces within man, individually and collectively. Otherwise the recurring fratricidal conflicts of the past will be supplanted by a monstrous genocidal conflagration.
Shortly before his death, Carl Gustav Jung wrote a sobering article pointing out that relatively few people take seriously the fact that man has an unconscious mind which influences everything he does. The potentialities in the unconscious represent almost unimaginable destructive or creative forces. The importance of whether they are used destructively or creatively has been magnified a thousandfold by what Jung referred to as "that peculiar flower of human ingenuity, the hydrogen bomb." ("God, the Devil and the Human Soul," The Atlantic Monthly (November, 1957), p. 61.) Looking to the foreboding future, his words should have an authentic ring to the ear of a Christian: "Virtually everything depends on the human soul and its functions. It should be worthy of all the attention we can give it...."( Ibid., p. 57.)
Racial Justice and Mental Health
The late Dorothy W. Baruch once described a child who kicked her when he came to her office because he was angry with his mother. She commented that she was glad that he could learn, through psychotherapy, how to handle his angry feelings constructively. She said that she preferred having a temporary shin bruise to having him kick Negroes, Mexicans, or Jews when he grew up.( Dorothy W. Baruch discusses the roots of prejudice in New Ways in Discipline, pp. 38, 57, 140, 230.) A study of the psychology of prejudice, reported in The Authoritarian Personality,( T. W. Adorno, et al. (New York: Harper 8c Row, 1950) showed that prejudice is often associated with personality distortions. A person who is frightened by life and unable to accept his own negative impulses may project these onto minority groups. This is the underlying cause of scapegoatism. A comprehensive survey of the research studies on prejudice (Gordon W. Allport, The Nature of Prejudice (Garden City: Doubleday & Company, 1958) showed that some prejudice is a result of culturally conditioned attitudes and is not the result of deep personality illness. The sickness is societal rather than individual, although disturbed individuals often rise to leadership roles in such situations.
Discrimination is prejudice in action. The negative effect on the mental health of those segregated was basic in the supreme court's milestone decision on public school desegregation in 1954. Separate facilities are inherently unequal because of the psychological effects on the excluded group. The psychological damage to those doing the segregating is more subtle and insidious. James Weldon Johnson once said that the race issue is really a struggle "to save black America's body and white America's soul."
The churches can never become the healing forces which they should be in the area of mental health until they heal the sickness of segregation within their corporate life. As Fred D. Wentzel put it: "The church must continue to be weak and self-defeating in its efforts to create the brotherly society until it begins to represent in its own attitude and practice an all-inclusive fellowship. It is now a very sick man telling everybody how to be well." (Gordon W. Allport, The Nature of Prejudice (Garden City: Doubleday & Company, 1958). The responses of the predominantly Caucasian churches to the brotherhood revolution that is currently sweeping this country has been, with some notable exceptions, a disappointing page in Christian history. When we cut the roots of prejudice and provincialism in the churches a giant step will have been taken toward releasing their spiritual integrity and healing power.
The Population Explosion and Mental Health
The population explosion is a world-wide threat to mental as well as physical health. Each week some two million babies join the world population, the majority of them in areas already overpopulated and underfed. The hungry two-thirds of the world is growing twice as rapidly as the affluent one-third. Two-thirds of the economic progress made by underdeveloped nations since 1950 has been wiped out by the population explosion. The basic cause is not an increased birth rate but the radically decreased death rate, resulting largely from antibiotics and disinfectants developed during World War II. To illustrate, in a generation life expectancy in India has risen from twenty-three to forty-eight years.
The world population did not reach one billion until 1830, but it took only another hundred years to reach two billion, and another thirty years to reach three billion (in 1961) . If the present rate continues, over six billion persons will huddle together on the globe by the year 2000, and in another six hundred years each inhabitant will have only one square yard on which to live.( The figures cited and the quotations are from "How Many Babies Is Too Many?", Newsweek (July 23. 1962), pp. 27-30.) Sir Julian Huxley, former UNESCO director, regards birth control as the only real hope in the problem and terms it "a prerequisite for anything that you can call progress and advance in human evolution." He holds that the population explosion is "the gravest problem of our time," more serious than war or peace, in the long perspective. It is obvious that unless the explosion is checked, it will produce a nightmarish spiraling of all manner of personality-damaging social problems.
What can churchmen do? Individual couples can practice responsible family planning. Denominations can take a forthright stand (as several have done) holding that responsible family planning through the use of the most effective contraceptives is not only ethically permissible, but is the only Christian approach to parenthood in the face of the population explosion. There is need for continuing exploration of possible ways of obtaining Roman Catholic cooperation on this issue. Whether or not such ways are found, nonCatholics have an obligation to give moral support to birth control education programs beamed at all parts of the world. The goal, as an American State Department official has put it, is "a world in which every birth is accompanied by a birthright."
Inexpensive, easily used contraceptive methods are now available. Whether or not they are used widely enough to interrupt the geometric progression of the population increase depends on the motivation of parents. This is an area needing much additional research. Commenting on the situation in his country, a Pakistani leader declared: "Sex is the only poetry known to the poor man. He procreates when he is happy, procreates when he is unhappy, procreates when he is indifferent." Theological as well as medical issues are involved. In New Delhi, a woman said, as she sat in the doorway of her mud hut nursing her fourteenth baby, "These are all Godgiven-children." (Ibid)
Neurotic Aspects of Our Culture
Those who have explored the social factors in personality growth have found that there are certain characteristics of our society which stunt such growth. These factors make it difficult for adults and children to maintain mutually satisfying, growth-nurturing, relationships. Penetrating analyses of these factors have been made by Karen Horney,( The Neurotic Personality of Our Time (New York: W. W. Norton & Company, 1937) by Erich Fromm,( The Sane Society (New York: Holt, Rinehart & Winston, 1955) , and by David Riesman.( The Lonely Crowd (New Haven: Yale University Press, 1950).
A basic factor which makes it difficult to maintain warm, intimate, need-satisfying relationships is the extreme competitiveness and pressure to "succeed" in terms of power, property, and prestige. Closely linked with this are the prevalent feelings of isolation, alienation, and depersonalization. Rollo May has described our times as the "schizoid age" -- our age of unrelatedness.( The Lonely Crowd (New Haven: Yale University Press, 1950). T. S. Eliot expresses the aching loneliness of modern man through one of his characters in The Cocktail Party:
Do you know --
It no longer seems worthwhile to speak to anyone.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No . . . it isn't that I want to be alone,
But that everyone's alone . . .
They make noises, and think they are talking to each other;
They make faces, and think they understand each other.
And I'm sure they don't.( The Cocktail Party (New York: Harcourt, Brace and Co., 1950), p. 134.)
There are many reasons for the unrelatedness of our times. Prominent among them is the mass migration to the anonymity of the city. Moving from a small town where one was surrounded by friends and clan to a large city where "people are lonesome together" is a "detribalizing," shaking experience. Alan Walker has noted that the Wise Men lost sight of the star when they reached the big city. Modern city man often loses sight of the star of his own worth and meaning. He rapidly becomes mass man -- feeling lost in the subway herd, a cipher in the census statistics, a punch card in his company's computer. He feels helplessly caught in the swirling vortex of economic, political, and population forces over which he has little, if any, control.
The competitiveness of our society with its ruthless drive to "get ahead" is in part a result of the lack of mutually satisfying relationships. People who do not have deep relatedness often substitute competitiveness and its rewards. But competitiveness is also a cause of this lack of relatedness. Here again the cause-effect factors are circular and self-perpetuating. The child who grows up in a highly competitive family feels that he is valued only as he can bring success to his parents. His deep need to be loved for his own sake is thwarted, and he comes to value himself and other human beings only as he or they are instruments of success. His self-worth is based entirely on what Fromm calls the "marketing orientation" -- that is his ability to "sell himself." He depersonalizes others, seeing them as things to be used as he claws his way upward.
Ironically, as Fromm has put it, our society has produced machines which act like men and men who act like machines.( The Sane Society, p. 360.) The director of the Carnegie Tech Computation Center has suggested that western civilization has renounced man as an ideal and, in his place, has substituted the supercomputer. The rise of a machine civilization has depleted interest in the humanities and in artistic creativity. Graduates of engineering and technical schools emerge, he says, with no idea what man really is but with "a very clear and loving idea -- or ideal -- of what a computer is." ("Mathematician Says Computer Is Menace," Los Angeles Times (June 16, 1963) .
Another cultural reason for the prevalence of anxiety and insecurity is that the contemporary individual is no longer sustained by what Jung called the power of the "consensus Omnium."( The Undiscovered Self )
Gone are many of the supports which men found, in a more comfortable day, in widely accepted religious and philosophical certainties. Revolutionary changes in science and history have shaken the foundations of man's spiritual certainties. The current religious boom occurring simultaneously with declining ethical vitality probably is more a symptom of loneliness, anxiety, and searching for identity, than of faith.
What a church can do about all of this is the subject of this volume. Briefly, a church should become an island of sanity in our neurotic society, avoiding thing-centeredness and keeping persons at its heart. It should seek new, creative ways of bringing people suffering from "mass-itis" into small groups where they can experience depth relationships. Somehow the church will have to repent of its own scramble for quantitative success so that it will be capable of exposing the dog-eat-dog aspects of our culture for what they are -- sick. It must resist the temptation to peddle success-oriented religion to people who grasp it because they are too hungry to know the difference between a stone and bread. Most important of all, it must work to help people find a relevant, intellectually respectable faith and an experience of values so alive that "when you cut them they bleed."
Mental Illness and the Prophetic Ministry
The social problem which has the most direct pernicious effect on mental health is the inadequate provision which our society makes for the treatment of the major mental illnesses. Jesus' concern for the mentally ill was clearly evident in his healing ministry. As his followers, Christians should share this concern.
In 1955, Congress appointed a "Joint Commission on Mental Illness and Health" to make the first nationwide study of treatment resources and needs. The commission, composed of seventy leaders in the mental health field, reported in 1961. Its conclusion should touch the nerve of every Christian's conscience: "A large proportion of mental patients at present, as in the past, are not treated in accordance with democratic, humanitarian, scientific, and therapeutic principles. We have substantially failed the majority of them on all Counts." (Action for Mental Health (New York: Basic Books, Inc., 1961), p. 56.)
The most shocking fact revealed by the Joint Commission's report was that "More than half of the patients in most State hospitals receive no active treatment." (Action for Mental Health (New York: Basic Books, Inc., 1961), p. 56.) This is due mainly to the shortage of trained treatment personnel. Many patients are placed in what is euphemistically called "continued treatment" (which, in more honest language means "discontinued treatment"). Many are on these chronic wards because treatment was not given in the earlier stages before their illnesses became treatment-resistant. Some of these could still be reached with the newer treatment techniques if adequate staff were available.
If a member of one's family is hospitalized for mental illness, his chances of being released as improved or recovered are linked directly with the adequacy of treatment in that particular hospital. When a board from the American Psychiatric Association recently inspected 273 private, state, and federal mental hospitals, only 75 were approved as meeting minimal standards. Another 74 were conditionally approved. Of the 181 state hospitals included in this inspection, only 28 were placed on the approved list.( "Facts About Mental Illness" (The National Association for Mental Health, 1962) . Of all state and local government mental hospitals in our country, only 29 percent are approved by the Joint Commission on Accreditation of Hospitals.( Action for Mental Health, p. 19.)
Recent experience has demonstrated that many persons who are hospitalized for psychiatric disturbances would not need to be hospitalized if outpatient mental health clinics were available in their communities. At least 3,600 full-time clinics would be required to provide one such facility for every 50,000 persons which is the ratio recommended by the American Psychiatric Association. Only 1,400 now exist -- most of them part-time and with long waiting lists. (A study in Los Angeles County found that the average waiting period was twenty-six weeks.) (The Mental Health Survey of Los Angeles County, 1957-59" (Welfare Planning Council of the Los Angeles Region, 1960), pp. 129ff.) The existing clinics are unevenly distributed, fifty percent being in northeastern cities.
In discussing the condition of our nation's mental hospitals with a mental health group on the West Coast, psychiatrist William Menninger declared:
As we sit here, 750,000 souls are in human warehouses across America where they don't have enough doctors to shake a stick at, where 60 per cent are just sitting, rocking out their lives. I am convinced that the great majority of these 750,000 people could get well -- if enough folks cared. If enough of us did something about it, they would be out of the hospitals and contributing to our communities.( "Mental Health, Everybody's Business," Town Hall (June, 1961), p. 20.)
He went on to tell the story of the dramatic mental hospital renaissance in Kansas. Before the drastic upgrading of the hospitals, eighty percent of mental patients were hospitalized for life. Now the situation is reversed. More than eighty percent of first admissions go home within a year, seventy percent within ninety days. Admissions are continuing high, but people are getting well and going home because they are receiving intensive treatment immediately. More people are seeking treatment voluntarily because mental hospitals in Kansas are now places of hope.
Today, in some states, only forty-five percent of mental patients are discharged from mental hospitals. With good treatment, at least eight out of ten could return to their communities totally or partially recovered. What a tragic waste of human beings!
In spite of the continuing inadequacies in the current treatment of the mentally ill, remarkable progress has been made during the past few years. The year 1956 was a major milestone, when, for the first time since state hospital records had been kept, there was a decline in the total number of patients at that year's end. This decline has continued in subsequent years, despite the rise in the number of mental patients admitted each year and the country's growing population. Obviously, genuine progress has been made in treatment methods. The old "snake pit" atmosphere DO longer exists in the vast majority of state hospitals and the locks are coming off many wards.
There are a number of factors which account for the speedier release of patients. Tranquilizing drugs play the major role, drastically reducing the need for physical restraints, rendering many patients amenable to treatment, and often allowing them to leave the hospital much sooner than would otherwise be feasible. Intensive treatment units, where an all-out therapeutic effort is made immediately after admission, have produced impressive results. The therapeutic community approach, pioneered by psychiatrist Maxwell Jones of England, aims at making the entire experience of living together on a ward therapeutic in its effects. Every staff member down to the ward attendant shares responsibility for the therapeutic climate of the ward. The patients are encouraged to share in the responsibility for the total welfare of the group. Family therapy for the close relatives of the mentally ill is still another factor which helps the recovery of the patient. Remotivation therapy is a new method which has succeeded in reaching many long-regressed, "hopeless" patients.
The modern treatment approaches aim at keeping a patient in the hospital full-time for the briefest period possible, since the longer he stays the more difficult the readjustment to the community. As a patient improves, he spends more and more time at home. He may become a "night patient" or a "day patient," spending only part of each day in the institution. Recent improvements in community mental health facilities are making it possible to treat many at home who formerly would have been institutionalized. The thousand plus psychiatric units in general hospitals contrast sharply with the situation fifteen years ago when only a few existed. Such units are ideal for short-term and part-time treatment. Their general hospital location encourages earlier treatment, since a sense of stigma is less apt to be attached to going there. Day care centers, night hospitals, walk-in clinics (where persons in crisis can go for help without appointments), halfway houses, and foster home programs for recovering mental patients who cannot return to their families are examples of the types of new facilities that are beginning to appear in various parts of the country,
There is an exciting stir of hope in the air. Never before in the dark history of mental illness treatment has there been anything like the present surge of imaginative experiments in new treatment modalities. True, the majority of mental hospital doors are still locked and new facilities such as "day hospitals" are scarce, but the pace of progress is accelerating each year. The tide is turning in this long-neglected area.
Another sign of progress is the advance in the average amount spent daily per mental patient. These figures are encouraging in comparison with expenditures a decade ago. They are still absurdly low. Shortages of treatment personnel have gradually become somewhat less acute over the last few years. However, the number of registered nurses, trained social workers, and qualified psychiatrists working in mental hospitals is still far below an adequate level.
Because of the overall gains in treatment, the chances of recovery are improving steadily. For example, the likelihood of total or partial recovery from the largest mental crippler, schizophrenia, has climbed from twenty to seventy percent in the past forty years. Psychoses due to syphilis, pellagra, and lead poisoning have been practically eliminated through medical progress.
One of the major signs of hope in the treatment of the mentally ill is the active role that the federal government is now playing. Long-range improvement in both the prevention and treatment of mental illness depends on two factors -- training of mental health workers and research. The National Institute of Mental Health has the major research and training-grant program in the country. Progress is clearly evident in the rise in congressional appropriations for this center from $18,000,000 in 1956 to over $100,000,000 in 1960.
The development of more adequate treatment facilities received a powerful boost in 1963 with the passage of federal legislation providing for the development of a pilot community mental health center in each state. The impetus which led to this legislation came from President Kennedy not long before his death. In the first presidential message to Congress dealing solely with mental illness and retardation, he gave this ringing challenge: "Shabby treatment of the many millions of the mentally disabled" he said, "has gone on too long. We can procrastinate no more." (Time (February 15, 1963), p. 44.)
In response to his call for "a broad new mental health program," Congress appropriated funds to stimulate state and local action in creating intensive treatment centers and to encourage research on mental retardation. State and local governments will form a partnership with the federal government in what will become a step toward more adequate care of the mentally ill and retarded.
A Plan of Action for the Local Church
Here is a practical plan by which a church can exert its maximum influence on a community's efforts to provide better treatment for the mentally ill. As in all community problems, a church should be involved in two ways -- through its organizational life (for example, a social action committee) and through the mental health witness of individual church members in the community. Here are some of the ways in which a church can help in the fight to conquer the scourge of mental illness:
(1) The church should help to build a broad foundation of enlightened heart-understanding of mental illness.
Churches can play a strategic educational role in constructing a foundation for mental health action in the community by developing increased understanding of the problems of mental illness. The educational opportunity created by the churches' direct face-to-face contact with 120 million adults and youth is immense! The crucial goal of such education is to change negative attitudes toward mental illness and to dispel the miasmic cloud of fear, stigma, and mystery that still surrounds it. In his autobiography, Harry Emerson Fosdick tells with complete candor of the nervous breakdowns suffered by his mother, his father, and later himself. This matter-of-fact, relaxed objectivity demonstrated by one of the most creative religious leaders of our century is a refreshing illustration of the goal of mental health education.
Why is it that we still reject, stigmatize, and provide only halfhearted treatment for the mentally ill in spite of the millions of words that have been written and spoken to promote an enlightened approach to the problem? The report of the Joint Commission is brutally frank on this issue:
One reason the public does not react desirably is that the mentally ill lack appeal. They eventually become a nuisance to other people and are generally treated as such.... People do seem to feel sorry for them; but in the balance, they do not feel as sorry as they do relieved to, have out of the way persons whose behavior disturbs and offends them.( Action for Mental Health, p. 58.)
The basis of the stigma is fear -- fear of what the irrational person might do, fear that we might suffer a similar fate. In addition to fear, there is the suspicion in some minds that the person really brought the problem on himself. In guilt-ridden people this leads to the urge to punish -- an urge that is obvious in relationship to illnesses such as alcoholism and sexual perversions. It is also present in other forms of personality illness. Remember that many mentally ill persons were still chained to the walls of jails and almshouses a little more than a century ago in America (see Chap. 12) .
A church's approach to mental illness education should emphasize the fact that, with a few exceptions, mental illnesses are treatable illnesses. It should communicate the kind of realistic new hope for the mentally ill which now exists. William Menninger has declared that contrary to the widespread opinion that mentally ill persons seldom get well, mental illnesses have the highest recovery rates of any group of illnesses. If patients are given a fair chance, from seventy to ninety percent can recover.( See "Mental Health, Everybody's Business.")
Education on mental illness always should be integrated with an emphasis on positive mental health. It is educationally valid to present them together. The cold chill which the subject of mental illness elicits in many people needs to be offset by the warm sunlight of an emphasis on positive mental health. Prevention and treatment together constitute the whole picture of mental health which people need to see and understand.
Mental health education should acquaint learners with rigorously accurate information concerning the size and seriousness of the problems. It should communicate an understanding of the nature of mental illness that will help to erase the inaccurate stereotypes about it (that is, it should include facts showing that the proportion of mentally ill persons who are wild and destructive is about the same as the proportion of planes that crash as compared with the total number of planes that fly.) Ideally, mental health education should take place in small groups in which the distorted attitudes and feelings of the participants can be worked through. Even more effective as an attitude-changing experience is firsthand contact with recovering patients in a progressive mental hospital.
(2) A church should cooperate with other groups to improve treatment facilities in its area.
There are now forty-seven state associations of mental health and over eight hundred local chapters affiliated with the National Association for Mental Health, 10 Columbus Circle, New York, N. Y. These citizens groups are working to improve care of the mentally ill. Such groups can be highly effective instruments for stimulating and coordinating community mental health activities. A local church's social-action or mental health committee should support such an association vigorously. Where no Mental Health Association exists, churchmen should consider spearheading the formation of such a group. Paul B. Maves tells of a minister who was one of the key persons in establishing a mental hygiene society in New Jersey. Another clergyman took a similar role in Ohio.( The Church and Mental Health, p. 224.) State or local mental health associations can provide church social-action groups with current information concerning the problems and needs of their area, including mental health legislation which needs citizen support.
Patient care can be improved through volunteer service in clinics and hospitals. At a large mental hospital on Long Island, women from nearby churches established the "Protestant Service Organization," through which they give thousands of hours of volunteer service each year. They assist the chaplain in the religious program, organize parties and picnics, and in a variety of other ways show the patients that the church and the outside world have not forgotten them. Monthly birthday celebrations are held for patients, including the some six hundred who have no families or whose families have rejected them. At a mental hospital in Minnesota, young people, mainly from the churches, volunteer to lead folk dances, songfests, softball games, and parties. The girls among the volunteers administer home permanents during "Toni Time." These programs have had a striking effect on the morale of the institution they serve.
For over a decade Oberlin College students have had a volunteer program at a nearby mental hospital. A study of the patients visited regularly by the students (compared with a matched control group of other patients) showed that the program had made a significant difference in the general improvement and discharge rate of those visited. Not everyone is suited to work with mental patients, but other important work can be found by the chaplain or the hospital's Director of Volunteers. "Wanted -- Your Magic" is the title of a useful pamphlet for enlisting volunteers.( New York State Society for Mental Health, 105 East 22nd Street, New York, New York.)
Church leaders and church groups can help to identify the major gaps in their community's mental health service and work with others to fill them. A large suburban area in New York was, until recently, utterly lacking in mental health facilities for children. It happens that a relatively small service group within that community became aware of this need and took the initiative. After gathering data from the schools, police, and social agencies that would confirm the existence of the need, this group succeeded in rallying the community to establish a child guidance clinic. Approval of the project was obtained from the county medical and psychiatric societies. Throughout the project there was a close working relationship between citizen committees and the mental health professionals. Educational meetings open to the public were held regularly. Memberships in a child guidance association were solicited throughout the community. Contributions began to come from various sources. As funds became available, a professional personnel committee began to interview prospective staff members and a facilities committee found housing for the clinic. Finally, after two years of hard work by scores of persons, including many of the religious leaders of the community, a new child guidance clinic opened its doors. Because of the grass-roots interest generated during its formation, community support continued at a high level. After a year of successful operation, the clinic was able to qualify for matching funds from the state to expand its services.
For the first time in the history of our country, a concrete, comprehensive plan is available for developing adequate treatment facilities for the mentally ill. It is contained in Action for Mental Health, the final report of the Joint Commission on Mental Illness and Health. A church's mental health committee profitably could study this plan and use it as a basis for action. These facilities are called for by the plan: (a) Community mental health clinics serving both adults and children are the main line of defense in reducing the need for prolonged or repeated hospitalization. One clinic should be available for every fifty thousand persons. (b) Every community general hospital of one hundred beds or more should have psychiatric beds to provide short-term and emergency treatment. (c) Intensive treatment centers, never larger than one thousand beds, are recommended to replace present state hospitals. They would be located regionally and would have a well-trained staff at least as large as the patient population. They would concentrate on treating those in the acute stages of a mental illness. (d) According to the plan, all existing state hospitals of more than one thousand beds should be gradually converted into centers for the care of chronically ill persons, both physically and mentally ill. Special therapies for helping chronic patients have been developed and are applicable to both types. (e) Aftercare and rehabilitation services are essential since the goal of this program is to keep hospitalization at a minimum. Such services include night hospitals, day hospitals, nursing homes, foster family care, work services, rehabilitation centers, half-way houses, and ex-patient groups. (f) Resident schools for the reeducation of emotionally disturbed children were also recommended by the plan.
Other services which a community should have in order to meet its mental health needs are: psychological services in the schools and social agencies, services for the mentally retarded, psychiatric treatment for juvenile and adult offenders, a suicide prevention center, a clinic serving alcoholics and, very important, Alcoholics Anonymous, Alanon, and Alateen groups. Ideally, most of these services should be located and/or coordinated in a community's mental health center (with the exception of A. A., Alanon, and Alateens). This should become the nerve center of the total mental health thrust of a local community.
(3) A church should encourage the recruitment and training of persons for the mental health professions.
In spite of recent gains, the critical shortage of trained personnel is still the crucial factor retarding the improvement of treatment programs. In most mental hospitals there are shortages in all the mental health professions: psychiatrists, clinical psychologists, social workers, psychiatric nurses, occupational therapists, and clinically trained chaplains. At present there is one chaplain for every 1,600 mental patients. These chaplains represent the church's most significant direct ministry to the mentally ill. The denominations should do everything possible to recruit and train additional chaplains so that the chaplain/patient ratio could be reduced to 1/600.( Richard V. McCann in The Churches and Mental Health, p. 39, suggests a 1/800 ratio.)
Each local church should encourage some of its most able young people to enter the mental health professions, regarding them as Christian vocations in the most significant sense. Attractive representatives of these professions may be invited to speak at youth meetings and Christian vocations conferences on topics such as "Psychiatric Nursing as a Christian Calling." Service in mental hospitals as volunteers helps stimulate interest in these careers. Several of the students from the Oberlin project have subsequently chosen mental health careers as a result of their experiences as volunteers. The National Institute of Mental Health has produced an excellent booklet on "Careers in Mental Health," (Public Health Service Publication #23 (National Institute of Mental Health. Bethesda 14, Maryland). which should be among the vocational guidance resources of a church.
(4) Churchmen should give active support to legislative efforts designed to provide increased mental health education, research, and treatment.
The problems of mental health are too gigantic to be handled, in the long run, on any except a total community basis. Chances for a major breakthrough improve as local, state, and federal levels of government each play increasingly responsible roles in mental health. As indicated above, this process is gaining momentum. The rising tide of hopeful programs confronts churchmen with an opportunity to exercise their ballots and use their influence to support constructive mental health measures. The anti-mental health letters which every legislator receives must be offset by communications from pro-mental health persons. When key mental health legislation is before state or municipal governments, it is essential that enlightened Christians exercise the power of the pen. Opponents are often well-organized and vociferous. Mental health is everyone's business but not everyone will accept his responsibility. In most cases, the decision of a municipal government concerning whether or not to implement state or federal legislation by establishing a local mental health center is the result of the work of a small minority of citizens who cared enough to express their views pro and con.
In addition to backing every sound effort to provide better treatment for the mentally ill, churchmen should throw their weight behind legislative efforts to prevent mental illness. In practical terms this means more education and research. About one percent of the twelve billion dollars spent annually on research in our country is spent studying people and their problems. The amount invested in research on mental illness and health in a recent year was about the same as the cost of the Triton nuclear submarine. One hundred million dollars were spent on the research that resulted in the polio vaccine. Certainly no one regrets this expenditure. The same perspective should apply to mental illness. Even greater sums doubtless will be necessary to produce the research discoveries in the hidden causes of mental illness, which are essential both to more effective treatment and to prevention.
A local church should take its place on the front lines in the battle to conquer the scourge of mental illness. One of the subtle but valuable contributions which participation of religiously-motivated persons brings to the mental health activities of a community is a spirit of dedication and quiet enthusiasm. Lawrence K. Frank, a leader in the mental health movement has observed that if a community's mental health program is to draw on the strengths of our culture and to have meaning for the majority of people, it must be presented as more than a psychiatric proposal. It must succeed in enlisting much of what people mean by their religion,
When Christians are religiously concerned there is a vitality to their dedication which becomes a subtle leavening influence in everything they touch. This spirit is very much needed to help overcome the stolid apathy that so frequently retards community mental health efforts.
Implementing the Prophetic Ministry
There are at least four channels through which the prophetic ministry can be implemented: (a) prophetic preaching, (b) study-discussion groups (and other educational programs), (c) social action groups, and (d) action by individual members through community social action projects. These four methods can be applied effectively to the many social problems which plague local, national, and world communities. In sermons and lectures on prophetic issues, it is particularly important that concrete suggestions be made concerning what the hearer can do. Small, practical "next steps" at the close of such a presentation help to motivate action and to put to work the concern that has been aroused. Since most social problems are vastly more complicated than the uninformed person even suspects, disciplined study in small groups, focusing on a particularly urgent social issue, can prepare people to act wisely.
Unfortunately, many churches today seem to have replaced militancy on social issues by a bland irrelevance.( For a searching article on this problem, see Ronald E. Osburn, "U. S. A.: The Need for Renewal:"The Christian Century (April 4, 1962), p. 420.) In our era of the "soft sell," the danger of a church becoming a chameleon without knowing it is great. The discovery of one's personal prophetic ministry as a Christian is a very good thing for one's mental health, as well as for one's church and community. Finding an "object of devotion" that really matters brings a new aliveness to an individual. The same is true for a church group. I recall the awakening of a social action committee which decided to launch a community effort to deal more constructively with the problems of a slum-ghetto. A year before her death at seventy-nine, the greathearted humanitarian Eleanor Roosevelt wrote: "There is so much to do, so many engrossing challenges, so many heartbreaking and pressing needs." (Brochure of the Eleanor Roosevelt Memorial Foundation, 1963) If a church catches something of this spirit of urgency and challenge, if it comes alive to the problems of its community and world, the cause of mental health will prosper.
Allport, Gordon W. The Nature of Prejudice. Boston: Beacon Press, 1954.
Fromm, Erich. The Sane Society. New York: Holt, Rinehart & Winston, 1955.
Joint Commission on Mental Illness and Health. Action for Mental Health, A Program for Meeting the National Emergency. New York: Basic Books, Inc., 1961.
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