By
Patrick J. McNamara, L.C.S.W.
Guest
Columnist
West
Palm Beach, FL, USA
As
a species, we human beings are profoundly social creatures. The more we come to
understand about the human brain, the more we see how fundamental our social
connections are to our well-being. Yet how we relate to each other has been
changing rapidly in the 21st Century. Ironically, while we have
never been so digitally
connected, we are also recognizing that loneliness and
social isolation are reaching epidemic proportions. In many ways, we are able
to live in separate worlds, oblivious to the experiences of people we don’t
encounter. Is there any connection between these phenomena and our rising
challenges in mental health, or brain health as I prefer to call it? The
emerging data, social neuroscience, and my experience lead me to believe that there
absolutely is. As a clinical social worker turned CEO, I have had the privilege
of learning a few key lessons along my personal and professional path that
offer a way forward, a way to enhance our social connections while improving
our brain health.
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| Patrick J. McNamara |
After
finishing graduate school in 1995, I joined the Community Treatment Team at a
local mental health center in south Florida. We were intensive case managers
serving folks with severe mental illnesses and addictions. Specifically, our
clients had been living in institutional settings, and we were charged with
helping them to reintegrate in the community. On my first day of work, my
partner Vinny and I drove to a boarding home to make a few home visits to our clients.
As we neared a dilapidated building with newspaper covering broken windows, I
saw a shirtless, skinny man standing on the sidewalk, wearing a large straw hat
and spraying deodorant under his arms. “Joe” greeted us with a smile from ear
to ear and he invited us into his room, with a mattress on the floor, for a cup
of coffee. This was the beginning of my first lesson.
Lesson One: People living with a severe mental
illness are some of the most resilient, incredible people on the planet.
Joe
had grown up in the Midwest and moved to Florida with his brother in his early
twenties. He was working in construction when he began to hear voices and
develop delusions about aliens. After winding up in a local hospital, he was
committed to the state psychiatric hospital where he remained for several
years. He then preceded to cycle in and out of jail, boarding homes, and local
hospitals. While Joe was never able to hold down a job again, he qualified for
social security disability, the primary source of financial support for US
adults living with a severe mental illness. He developed several friends,
attended a drop-in center, and was an avid fan of the Kansas City Chiefs. Joe
had a wonderful sense of humor and was known to be generous with his friends. Getting
proximate and being in relationship with people living with a mental illness
has transformed any sense of stigma I harbored into respect for them and the
challenges they face.
Seeing
Joe live in the squalid conditions of the boarding home bothered me greatly. Consider
this for a moment: it’s hard enough for a person to learn to live with a
psychotic disorder. It’s a challenge of another magnitude to consign that person
to live in abject poverty. Can you imagine trying to live off of $650 a month,
including all your housing expenses? This injustice made me angry repeatedly. This
is when I learned my next lesson from an age-old spiritual leader.
Lesson Two: Saint Augustine said, “Hope has two beautiful daughters: their names are Anger and Courage. Anger at the way things are, and Courage to see that they do not remain as they are.”
Lesson Two: Saint Augustine said, “Hope has two beautiful daughters: their names are Anger and Courage. Anger at the way things are, and Courage to see that they do not remain as they are.”
I
used my anger at the social injustice of deinstitutionalizing our most
vulnerable neighbors without the necessary supports to live in the community. I
made the case for supportive housing as an answer. And I scrapped, scrounged,
and advocated to create new housing resources.
While
history demonstrates that we’ve made progress in our treatment and
understanding of brain disorders, we have a long way to go – particularly in
reconciling our understanding with policy changes. The deinstitutionalization
movement began in the 1960s in an attempt to provide more humane treatment of
persons with mental illnesses while also cutting expenses for state-run asylums
and hospitals. The conditions and practices of these hospitals were often
brutal and destructive. New drugs and growing awareness of the plight of the
mentally ill offered great promise. Unfortunately, good intentions have never
garnered the necessary resources for properly transitioning care into the
community. As a result, our neighbors with severe brain disorders constitute
the majority of our homeless and disproportionate number of incarcerated adults
in the U.S. This is beyond tragic. I have seen how well-crafted, evidence-based
solutions, such as supportive housing, are not only cost-effective, but also
significantly effective in improving quality of life. In fact, people with a chronic
mental illness can and do recover with the proper supports.
Ongoing
research on brain disorders and effective treatments are vital. The good news
is that there has been an explosion of scientific research and understanding
about the human brain over the past two decades. This is exciting – but continuing
breakthroughs need to be supported! It’s beyond time to move from the headlines
of our rising mental health challenges to meaningful action. Through public-private
partnerships, the time is now to invest heavily in advancing brain research and
effective treatments. Interestingly, one of the most consistent findings from
this research is the powerful effect of a supportive relationship. The social
nature of our brains has evolved to depend on relationships to both heal and
thrive. Beyond medications, we have learned through advanced forms of imaging
that relationships actually change our brain.
Lesson Three: A
consistent, supportive relationship is profoundly important to smooth the ups
and downs of a person struggling to overcome adversity. We are social creatures
– our brains are wired to connect.
Acts
of gun violence have recently been conflated with mental illness. The fact is
that people with a mental illness are no more likely to commit an act of
violence than the general population, and they are more likely to be
victimized. That said, acts of violence and aggression are brain-based
behaviors with multiple contributing factors. Social isolation and
disconnection are among them. After the horrifying, nearby shooting in Parkland,
our State has responded both with “hardening” the security of our schools and
with funding mental health services in schools for the first time. Now the
First Lady of Florida has announced her signature initiative to be “Hope for
Healing,” focusing on improving mental health for children and families. It is
my sincere hope that we will heal and find new ways to prevent future
tragedies. I believe that social connection, advanced brain research, and
access to treatment are major parts of the solution.
Reflecting
on my personal and professional path, I learned:
Lesson Four: I was most
impactful when I recognized the inherent dignity of each person I was trying to
help and acted accordingly.
While
I made many mistakes and had many failures, practicing dignity was the
essential ingredient of the positive changes I witnessed. Relationships are
hard, but practicing dignity calls us to rise to the challenge. Consider the
increasing mental health challenges that we face, race and health disparities,
our rapidly growing aging population, and the future of our children. How might
the future look if each of us decides to draw closer to those we encounter in
need? We just might learn together the art of practicing dignity.
Link:
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Patrick J. McNamara, L.C.S.W., is the
President and Chief Executive Officer of Palm Health Foundation, Inc., the
leading public healthcare foundation in Palm Beach County, Florida, whose
mission is to build strong community partnerships,
respects diverse opinions, advocate for its most vulnerable neighbors and
inspire innovative solutions to lead change for better health now and for
generations to come.