07 Oct The Pope, Prisons, and World Mental Health Day
Written by: Bart Magee, Ph.D.
Saturday, October 10, 2015
“Any society, any family that cannot share or take seriously the pain of its children, and views that pain as something normal or expected, is a society condemned to remain hostage to itself, prey to the very things which cause that pain.”
Those powerful words were spoken last month by Pope Francis as he visited inmates at a Philadelphia prison. While he made them in a particular setting, I want to put meaning of those words in a larger context as we mark World Mental Health Day, Saturday October 10th.
Every year the World Health Organization observes World Mental Health Day as an occasion to raise awareness about mental health issues with the goal of ensuring that people with mental health conditions live with dignity. This means encouraging national and international policies that reduce stigma, advocating for increased funding for training and treatment, sharing information about the best practices, and mobilizing a more robust response to mental health problems worldwide.
How is it possible, really, to get our minds around the global issues related to mental health? Problems so large and diverse defy comprehension. I think the Pope’s words can help us focus on what we can all understand and respond to, the more fundamental and human, that which speaks to our shared connections and responsibilities.
The Pope was speaking about prisons in particular and the pain he feels when he encounters a prison system not concerned for the care and the suffering of its inmates. Our attempt to isolate them, treat them as not human, condemning them to suffer is not only morally wrong, he says, but dooms us to endlessly repeat that which causes the pain in the first place.
The same can be said of the way we treat people who experience the kinds of “psychic pain” that leads to mental health problems. Historically, across societies and cultures, we have isolated and alienated people whose suffering manifests primarily in their mental and emotional lives. (The link between the way we treat prisoners and mental health patients is literal as well as metaphorical. In the US, as well as many other countries, the largest mental health facilities are, in fact, jails.)
As a society we haven’t taken psychological pain “seriously”. We say, it’s something that will pass, or we should just get over it, or it’s all in your head, as if to say it’s made-up and meaningless. We limit treatments for mental illness in a way we would never do for a physical disease. This approach has never worked; dismissive attitudes only exacerbate the problems. When you add rejection, shame and isolation from family and social life to psychological suffering it adds further injury, trauma actually, causing the original problem to metastasize. Then we see more serious symptoms, including, physical illnesses, substance abuse and self-harming or anti-social behavior. Escalations do tend to get our collective attention, but the responses often are not helpful. The interventions typically utilized, ranging from various kinds of medical treatment all the way to incarceration, not only fail to address the person’s real suffering, but come at a tremendous financial and social cost. We invest in unnecessary and ineffective care, then complain about it and become demoralized when the problem doesn’t go away.
A kind of understandable hopelessness, helplessness and fear set in and reinforces the judgmental and stigmatizing policies and practices that I believe the Pope was talking about when he said that we “remain hostage” to the very pain we are supposedly trying to address.
So what’s the way out? The answer is not as difficult as we might imagine, but requires a radically different mindset and approach. First, we must stop treating mental illness as an individual problem and take responsibility collectively. We get far too obsessed with individual conditions, diagnoses, and a myriad of treatment options. Treatment is more often focused on symptoms and searches for quick fixes and technical solutions. I encounter many patients who have gotten nowhere with this kind of atomized, limited, “whack-a-mole” methodology. Effective mental health treatments are built from a thorough assessment, one that considers the whole person, a developmental history, contextual, familial, social and, yes, unconscious factors and a treatment plan that fully engages the patient. Treatments that work best are multifaceted and address psychological, biological, social and spiritual issues together. Ultimately, we do ask that patients take responsibility effecting change, but we can only really do that if we as friends, family members, providers and a society also take responsibility for providing care that is tailored to the unique and deeply human needs being expressed and continues throughout the healing process.
This approach would mean reallocating resources away from prisons, emergency rooms, crisis programs and short term plans toward comprehensive, community-based, human-centered and longer-term care. I believe the change in mind-set comes first. If we can find the empathy and the moral resolve to truly take human mental suffering “seriously” then the resources and the funding surely will follow.