July 14, 2013
The 8th Sunday after Pentecost
In Chapter Seven of my book Transgender Good News I critique the profession of psychiatry as being more cruel and doing more damage to people in the name of mental health than prisons do to criminals in the name of punishment. My critiques include science based challenges of a wide array of research used to justify psychiatric theory and treatment. I also critique the professional arrogance and self-serving economic interests that influence the setting of diagnostic standards. This is not a critique of all psychiatrists. Some have worked for reforms of their professional organization, and some are Christians who recognize psychiatry as a Christian calling.
While recognizing that there are physiological aspects that are part of the causes of behavior that gets labeled as mental illness, I vigorously reject the reductionism that justifies the notion that unwanted behaviors are somehow just symptoms of broken brains. For example I understand that long term alcoholics may develop an irreversible condition called wet brain, but the physiological injury arises from, rather than causes, the habit we call alcoholism. As a result I would much rather direct people who are having trouble breaking the habit of drinking too much alcohol to AA than to psychiatrists who have added alcoholism to the list of psychiatric disorders they should treat.
Don’t get me wrong, I’m glad that a number of Seekers are getting the benefit of drugs that help them function better. However, recognizing that we are human animals with various injuries and diminishments doesn’t justify turning over human beings to psychiatrists who treat us as if it is only our animal aspects that matter.
The most maddening thing about psychiatry to me is the use of cultural standards to justify a medical model that turns non-conformity into mental illness. Reducing mental health to conformity is just as destructive, maybe more destructive, than reducing it to physiology. Many of these critiques are part of a petition signed by 13,000 mental health professionals who have challenged elements of DSM-V and call for revisions that include the perspectives of non-psychiatrists. DSM is the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association and DSM V is the latest effort to categorize mental illness.
I have critiqued the fundamental DSM paradigm on scientific grounds as severely flawed from its earliest beginnings. My theological critique is that DSM is the scripture for the the functional religion of psychiatry written for the purpose of recognizing only psychiatrists as the clergy in control.
I was a little late for the battle which led to the rejection of homosexuality as mental illness. I have made some contributions to the battle to reject transgender expression as a mental illness, including writing and shepherding a resolution through the General Synod of the United Church of Christ, the first policy statement on transgender issues by a Protestant denomination. The battle for gender freedom has not yet been won and according to DSM V I am still mentally ill because I meet their standards for gender dysphoria. I am pretty invulnerable to the assault of the American Psychiatric Association now, but if they had caught me as a teenager I would probably have been sent to the Chatahoochee State Mental Hospital in Florida where the standard treatment for boys like me was a prefrontal lobotomy. That’s where they stick a tool like an ice pick up through your eye socket and turn the part of your brain that makes you a human being into organic mush.
When I published Transgender Good News in 2004 prefrontal lobotomies were rare and the more common treatments were electrical shock treatment where they attack the brain with electricity and commonly get the same kind of compliance that they sought with lobotomies. The psychiatric deal is that when you stop making us uncomfortable we will stop abusing you into submission. In my book I include a case report of well meaning parents who brought a boy who liked to dress as a girl to a psychiatrist. He was placed in a state hospital. The parents were denied access to their child on the premise that they were part of the problem. The hospital lied to the parents about the treatment of the boy. The boy died from repeated electroshocks. I also included a report on behavioral treatment in Texas where therapists attached electrodes to a boy’s penis, showed him porn pictures, and shocked him if he started to get an erection.
As part of my training to become a hospital chaplain at Chicago Theological Seminary and the University of Chicago in the 1960s I did an internship at Elgin State Mental Hospital near Chicago. It was a visit to hell on Earth. I worked on two different wards. One was an overcrowded general ward with more than 200 “patients.” A group of teenage toughs terrorized the ward and the ward averaged a broken bone a day. The toughs stayed away from me and much preferred tormenting and hurting drugged up patients who were defenseless. I had a lot of sympathy for the toughs as well because their needs were not being addressed either. The other ward was a totally useless place for me to be, except to create a memory that is still bright. A couple of dozen older men drugged to stupor, tied into old fashioned wooden school chairs, openly catheterized to urine bottles so that they wouldn’t need to be taken to a bathroom, with nothing going on, no television, no conversation, just sitting in a circle in the middle of what was once a basketball court where they would sit until they died.
In the 1970’s, after getting my doctorate in sociology from Florida State University with the support of a four-year full fellowship from the National Institute of Mental Health, I fought in the battle that was called deinstitutionalization. I became Chair of the North Carolina Governor’s Committee on Deinstitutionalization that was part of a national initiative led by Rosalind Carter. My committee presented a near-unanimous report calling for closing one of the four state mental hospitals in North Carolina with the transfer of revenues to County mental health efforts including counseling, housing, and employment programs. The dissenting vote on the committee was from a psychiatrist. The report was turned over to a hired consultant from another state to put into final form for a legislative recommendation. Instead of the recommendation of the committee the report attributed to the committee was to maintain the status quo. I deeply regret that I felt compelled to avoid a public battle for reasons too lengthy for this sermon.
I have more stories to tell but I think you get the point that I’m preaching out of personal and professional anger. Don’t worry. My anger is nice, safe, prophetic anger aimed at the psychiatric profession rather than at Seekers. This is a sweet little affirmative sermon that just happens to include the implication of not turning control of mental health over to psychiatrists.
Part of the power of psychiatrists comes from alliances with conservative and liberal Christian and Jewish leaders. The conservative leaders were happy to discuss behavior they didn’t like as sick as well as sinful. The liberal leaders have been so interested in rescuing God from judgmental images of Hebrew Scripture and Christian testament; so committed to covering up social control with the public relations of “let’s be helpful,” that they turned a blind eye to psychiatric excesses.
Much was gained by turning over social control of behavior defined as mental illness to secular professionals and much change has been forced on the profession by legal challenges and legislative action. Other changes have been made by the profession under pressure from feminists, by critiques of therapeutic effectiveness that led to changes through insurance standards as well as legislative action, and by other political and cultural pressure groups.
I look to Jesus for my positive understanding of mental health, for reclaiming the salve of salvation. Here is our telling of the conversation between Jesus and a lawyer. (Luke 10: 25-37) (Conversation with Trish.)
Lawyer: What must I do to inherit eternal life?
Jesus: What is written in the Law?
Lawyer: You shall love the Lord your God with all your heart, with all your soul, with all your strength, and with all your mind; and you shall love your neighbor as yourself.
Jesus: That’s right. Do that and you will live.
Lawyer: But who is my neighbor?
Jesus: There was a man who set our from Jerusalem to walk to Jericho. Some robbers caught him, beat him up, and left him half dead. A priest came by, saw the injured man, and passed by on the other side of the road. A Levite came along and did the same thing. Then a Samaritan came along and was moved to pity. He bandaged the wounds of the injured man and poured on oil and wine as salve. Then he put the man on his animal, carried him to an inn, and took care of him. Then he gave two days wages to the innkeeper and promised to pay more if it was needed when he came back through.
Which man was the neighbor?
Lawyer: The one who showed mercy.
Jesus: Go and do likewise.
There are so many things to like in this story. I’ll restrain myself to a few.
The lawyer asked about eternal life and Jesus pointed to here and now life.
The lawyer was concerned about problems in ritual law such as the uncleanness of a corpse while Jesus pointed out that we should take care of each other when we are injured.
The religious leaders in this story are on the wrong side of the story because they refused to get involved in the messiness, cost, and obligations of healing.
The Samaritan was an amateur healer, not a professional, not a religious leader.
A member of a despised religion carried the gospel good news.
The healer paid for care rather than being paid.
The disciples of Jesus were able to do the same kind of healing that Jesus did and that they had no special training. There is no excuse for members of Seekers to back away from doing their part in healing each other and healing the world.
Here is some guidance from Jesus for the work of healing.
One. Jesus repeatedly tells those he healed that “Your faith has made you well. Go in peace.” Faith is an orientation, a way of living, that is not grounded merely in knowledge. The most important grounding of faith is embracing and living in harmony with what matters most as guidance even when we are confused, especially when we are confused. Prayer and Seekers conversations can help. We don’t have to be perfect to get better and and learn from our experiences.
Faith is easier when things are going well, when we are feeling blessed and appreciated, when we have the resources we need to live comfortably. Faith is hard, and all the more important, when times are hard, when life is unfair, when we are confused, anxious, and fearful. Faith is about being unpopular, even despised, when what is popular is wrong. It is about paying the prophets price to fight against bullying, torture, rape, racism and dangerous or exploitive working conditions. A lot of what drives people to depression, anger, violence, confusion, anonymity, alienation, hopelessness, suicide, and more, can be changed. Some things have been changed for the better but the “to do” list is still long. There is far more to do than we can reasonably hope to accomplish and that is no excuse for not doing our parts. And we need to confess that we all contribute to the distress that leads to the outrage and inrage that gets some people labeled as mentally ill, gets other people labeled as criminals. I don’t think that psychiatrists, Seekers, or our national political leaders often intend to be cruel, but we are very good at overlooking our contributions to cruel results.
Two. We are saved and we are healed as human animals. The lectionary story is easy to understand, a common situation and moment. A Jew is injured as a human animal. The injuries are obvious and the Jew is near death. A Samaritan amateur does what needs to be done as well as he is able with the resources he has.
We are human animals and we need the things that animals need: air, water, food, clothing, shelter, medical care when we are sick and injured. The Samaritan story has been part of the guidance that has led generations of Christians to create hospitality, hospitals, and hospices, for those who are hurting. Christian hospitality provided orientation long before science based medicine showed up. I think it is important to note that a lot of the tradition of Christian health caring was, and is, carried by women nurses and social workers.
I’m thankful that a lot of such caring goes on already in Seekers and that some Seekers are health professionals who are highly intentional about their work as a Christian calling to ministry.
Three. We are healed and we are saved as human animal who have become people.
We know nothing of the distinctive personal characteristics of the Samaritan in our story beyond that he felt pity. The Bible does not use the language “Good” Samaritan, just Samaritan. The Samaritan is not portrayed as a follower of Jesus nor does it attribute any religious commitment to the Samaritan. We have the same impersonal image of the injured Jew. He is just a victim. There is no prophetic assessment that he deserved to be beat up because of his sins or the sins of his great-grandmother. There is no chiding the Jew for not waiting and traveling in a caravan. Neither is there any assessment of the motives of the robbers. They just did what robbers do.
The story is not particularly interesting because help was given. Reducing the story to praising the Good Samaritan for being helpful obliterates the guidance of Jesus which shapes the story.
“Who is my neighbor?”
The lawyer asks the question because he recognizes an obligation to neighbors. This is like recognizing that we feel a special obligation to help each other as Seekers. We have expanded our caring about health within our community a lot in the last few years, most recently by trying to get better at helping troubled teens.
Skill and understanding is good. Caring matters more. Trish didn’t pass on the opportunity to accompany Liz on a late night trip to a hospital when she fell. She didn’t need any professional training for that. I’m sure that Liz appreciated that Trish had a car and not just a donkey for transportation.
Seekers is accompanying Liz in her journey of loss with the death of Cam. This doesn’t depend on professional training either. It arises from shared caring and shared faith built up over years of relationships. DSM V adds bereavement as a cause of clinical depression and that drives me crazy. It is blocking grief, isolating people who grieve, that is damaging.
Four. Who is my neighbor? Whom should I help? The story of a Samaritan who helped a Jew is a story about getting outside of our comfort zones, getting outside of Seekers, about the payment part of paying attention, about the trouble part of taking the trouble to help.
It is the caring of the Samaritan that matters most in this story. Such caring led Linda to South Africa and our current pilgrims to Guatemala.
Jesus said “Come and follow me” to some people but he sent most them on their own ways. Jesus is not in the business of offering healing as part of a come on for evangelism. It’s the other way round. Come to Jesus for salvation and you may end up with a calling to help others with their healing, to paying for healing service rather than getting paid. When we are paid as healers the unpaid aspect of caring may well be what matters most.
We contribute to mental health as an aspect of salvation when we follow our appreciation that there is more to life than eating, drinking, resting, and exercising; that more protection is needed than clothing and shelter, that more healing is needed than repairing broken brains. There is more to living than just living longer.
Forgiveness is part of the daily bread of salvation. I need to forgive psychiatrists, and religious leaders, while sustaining my anger as motivation to help things get better. I need to be forgiven when I do not handle my anger very well.
I care and I am thankful to live in this community of caring.