The man who kept kids from starving

April 26, 2016 by

From 2011

Hopeworks Community

from 2011

One of my favorite stories is the story of Jerry Sternin. He came to Vietnam in 1990 to try to come up with a way to address the issue of malnutrition especially that of child nutrition. Without any great theory of malnutrition or any great resources he found a solution and in the process showed the amazing power of a theory of human change called the theory of positive deviance. His idea was real simple. Even in the worst of situations he assumed there were people who were successful. Not all kids were dying of malnutrition. His idea was find the people who were doing things differently, who were successful and teach others to do the same thing. Find out what works and do more of it. And not only did it work it worked spectacularly. A description of his story can be found in many places but…

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To Linda….

April 25, 2016 by


A River cuts through rock…. On the battle to close the Gap

April 25, 2016 by



Insure Tennessee may as a proposal, as a product be dead and buried. Speaker Harwell has formed her task force and at least right now that would seem to be the case. But Insure Tennessee was never the river. It was just one vessel upon it. And I don’t know if they really understand that.

I fear they hope more than anything to change the subject. At least right now I fear so. I think they come not to fix Insure Tennessee or resolve their issues with it but to bury it and still the conversation. They are uncomfortable with people who don’t quiet when they say quiet. They are uncomfortable with people who would talk when they don’t want to listen. They don’t like it when people won’t wait. They don’t want to know some people can’t.

I don’t think anyone really knows what this task force means. It is important that we make the effort to help define that meaning. It is important that the task force not be about what they do when we leave but about our refusal to leave. It cannot be about the conversation they silence us with but our refusal to be silent in the conversation.

In the end it is a simple message. Leave no one behind. There are no acceptable casualties. No one is disposable. It is that simple.

This task force will not give us a verdict. This is not a final word. We have already given that. Three years ago the conversation to expand health care was a conversation we were told we could not even have. It is now a conversation that we must make sure can never be stopped.

What you do and what I do matters. The battle for Insure Tennessee or whatever it finally ends up being called has the ability to make a lasting and permanent impact on the state of Tennessee. Past any one battle, or set of circumstances we have the ability to make a difference that makes a difference. Years from now I think little may be made of who we fought with, but much will be made of what we fought for.

It is a battle for health care, but it is so much more than that. It is about justice and the possibility of fairness and whether or not poverty should mean that sickness and illness should bring with it a threat of unnecessary suffering and premature death. It is about whether or not Tennessee will decide whether or not it has a vested interest in the maintenence of the punishment of poor people for being poor. It is about whether or not a health system will be starved and brought to its knees in the service of a political agenda that neither reflects the values of Tennesseans or their best interests. It is all of these things but even more.

It is a battle for the meaning of people. It is about what the notion of disposable people means not just for those labeled such but for all of us. It is about the dignity of every Tennessean rather they have insurance or not. It is about what it means to be neighbors. It is about caring and love as more than a Sunday speech but as a living and vibrant thing. It is about who we are and who we can be. And as much as any single issue it is the truth of what Tennessee is and can come to be.

Let me be clear. My problem is not that the battle for Insure Tennessee was lost. My problem is that it was never fought. My expectation was not and never about victory. It was a fight being fought that I and 280,000 Tennesseans deserved to have been fought. It was about politicians doing something right for someone other than themselves. It was about people speaking for those never spoken for. It was about honesty and integrity and courage and not about elections and primaries. It should never have been held hostage to Donald Trump or Ted Cruz and it is a mark of shame to the state of Tennessee that it was.

But none of this need the final word. We are the river in the quote at the start of this post. The only meaningful question is not if but when. We need to be the change we advocate for. It is time to not apologize to anyone for acting like citizens of this state. It is time to let those know who would pander our hopes and needs away to political realities that we neither care for their politics or their narrow impoverished realities. It is time to tell people who want us to respect their dignity to acknowledge ours. It is time to tell people who get angry if someone makes them uncomfortable that for 280,000 Tennesseans comfort is the least of their issues.

We are the river.

I heard a story a few days ago about a homeless man in Knoxville. He had worked all his life and like it does for too many people things went wrong. He lost his job and his house and eventually they ended up on the streets. His wife developed cancer and the people who told me the story talked about how much they loved each other. She, they said, died in his arms on the streets of Knoxville. She never had any care. They were also in the gap. How long must we go on wondering who is next?

On AOT and human rights

April 25, 2016 by

Assisted outpatient treatment (AOT) is the psychiatric version of ocean front property in Arizona.  Even more than the assault on the PAIMI program written about in the previous post it is one of the crown jewels of the Murphy Bill,  a bill Rep Murphy tells us will rescue us from an unhealthy obsession with mental health and create a system based on mental illness,  which, he says,  is the only kind of system that will truly meet the needs of those with “severe mental illness.”

There are AOT laws in virtually every state now and I am honestly not sure why Rep Murphy thought there needed to be a national law but he did.   Initially the drive to national AOT looked irresistible but it looks now to face a very difficult path to becoming reality.   The original idea was to financially punish states that did not have AOT and force them to adopt a state statute.   The involuntary commitment of states to AOT did not exactly go over real well.  Rep Murphy did not help things by claiming that anyone who was against his proposals was so because of a personal stake or possibility of personal gain in defending a corrupt system that really didn’t care about the people it claimed to serve.   He burned every bridge and then seemed shocked that no one had come to stand with him.

The second version of the bill decided that perhaps a big stick might have been a little over the top and substituted a big carrot.   They would not punish those who did not have AOT.   They would pay those that did extra.   This version has gotten a little more support.   Some organizations have jumped on board since the overt nastiness was somewhat muted but for many people the coercive passage of a coercive Bill has not went well.  

I live in Tennessee which does not have AOT.   As much as I object to Tennesseans being committed I also object to Tennessee being committed.

AOT is based on a central irony I have never heard anyone even begin to explain.   Rep Murphy will explain to you in great details how the current mental health system really sucks.   He will tell you it does not in any way meet the needs of the “severely mentally ill”.   Then in the next breath he will tell you how important it is to pass a law that allows you to commit people,  force them to accept treatment in this awful system.  I  still don’t get it.   Is he saying that the system sucks (His rhetoric goes into overkill on this point) or is he saying that choice sucks.   He seems to have a great affinity for coercion as long as he is doing the coercion.

AOT is a little answer to big problems and the volume that Rep Murphy presents it at does not make it any bigger.   He throws out huge numbers of “severely mentally ill”  in jails and prisons and then tells you they are there because they were not coerced into mental health treatment.   Forget for a moment the remarkably simple minded nature of his reasoning.   Forget for a moment his seemingly endless faith in the power of coercive mental health treatment. Forget for a moment that he ignores the affects of poverty,  racism,  trauma,  homelessness,  drugs and many other social determinants of human behavior on crime.   Forget all that and look at AOT.

In most states it is far from a bustling success.   The numbers served in comparison to the numbers served in the entire system are miniscule.  New York,  which is the promised land of AOT serves last I checked about 2000 people… about 1/3 of 1%.  Perhaps if this is true in the state which tries harder than any other to commit people then there is not the widespread need for committal that Rep Murphy says underlies our current crisis.

They tell you that medical facts provide the foundation for the operation of AOT yet one study says that if you are black you are 5 times more likely to be committed than if you are white.  –

There are just many problems with the whole thing and more and more they are coming to roost.   Right now it looks doubtful that the Senate will drink the AOL kool-aid.   Even in the House there seems to be some reluctance to move forward on a bill that as written is so different than the Senate version.   They want a “bipartisan” bill to emerge but seem to be struggling with the idea that a bill based on the casual acceptance of coercion as a building block of the mental health system is going to have some problems with getting Democratic approval.   It is becoming more obvious that if Rep Murphy must have his way that there may not be any way.

Rep Murphy is going uphill right now.   That is obvious perhaps even to him.   But he is a true believer and is not going to stop.   And this is not a done deal.   As dangerous as AOT is and as dangerous as other aspects of the Murphy Bill are Rep Murphy is also dangerous.   There is no promise about what kind of deals people eager for some kind of deal might make in a conference committee.

Talk to your legislators.   Tell them you want mental health reform that actually addresses problems and not ideology.   Tell them that coercion is not part of any solution and that you do not believe justice and a respect for human rights are incompatible with helping troubled people build a better life.   Tell them to vote for you if they want you to continue to vote for them.

Rep. Murphy would have us have faith in a psychiatric vision and a system that has proven dangerous to too many people it had served.   He  asks us to have faith and trust in the good will and judgement of something less and less people have faith in.   He defends the power of a role that has progressively lost power and says the solution to the problems of the way things are now is to go back to the way things were.

If Dr Torrey and company are defeated here rest assured they will be back with the next shooting,  the next tragedy.   If they don’t make it on a national level they will be back at your state legislature asking for more power.   In some states they are already there.   Be vigilant.   Your voice matters but only if you use it.

I close this post with the words I started the previous post about PAIMI with.   They still apply perhaps even more on this issue than on PAIMI.

Thanks for your time.   Be well.

Only people with power believe that the
human rights of vulnerable people are not worthy of protection.   Only people with power would have us believe that the protection of those rights prevents them from the lawful and appropriate use of their power.   Only people with power would have us believe that those who would protect those rights are more dangerous and more trouble than those who would threaten those rights.   Only those with power would have us believe that the role of government is to get out of their way and not be concerned with how they would treat vulnerable people.   Only those with power would have us believe that they need to be protected from the people who would protect the vulnerable from them.

PAIMI and the defense of human rights

April 24, 2016 by

Only people with power believe that the human rights of vulnerable people are not worthy of protection.   Only people with power would have us believe that the protection of those rights prevents them from the lawful and appropriate use of their power.   Only people with power would have us believe that those who would protect those rights are more dangerous and more trouble than those who would threaten those rights.   Only those with power would have us believe that the role of government is to get out of their way and not be concerned with how they would treat vulnerable people.   Only those with power would have us believe that they need to be protected from the people who would protect the vulnerable from them.

PAIMI (Protection and advocacy for individuals with mental illness) is the governmental program set up to protect the rights of those labeled “mentally ill.”     Representative Timothy Murphy,  author of the Murphy Bill,  at one point last year dismissed the operations of PAIMI as “reprehensible”  and his bill as written would make sure that PAIMI no longer plays a  major role in efforts to insure the safety of anyone receiving services within the mental health system.   It would say the human rights of any person with mental health needs  is incidental or irrelevant to the quality of their lives.   It would say that those who would demand the human rights of those within the mental health system actually cripple the ability of that system to provide the services essential to the welfare of the most vulnerable people it serves.

The Bill would tell us to do other than what they suggest will threaten the ability of psychiatrists to exercise their legitimate authority. It would tell us that psychiatrists can and should be trusted with this authority, that they have knowledge and skills that others don’t have and to limit their authority would compromise the effective use of that knowledge and skills.

All of this is nonsense on many levels. No psychiatric diagnosis makes a person less a person and makes him any less deserving of the rights we would accord any other person. The reality of the possibility of manipulation, hurt, and injury that anyone with a psychiatric diagnosis faces from those who would control him “for his own good” is well documented and clear to anyone who makes any effort at all to open their eyes to the reality of what mental health treatment can be. Furthermore it is a slander to thousands and thousands of professionals who don’t feel their professional role should give them license to disregard the rights of others and that furthermore such disregard is neither helpful or essential to the quality of care any individual receives.

If you don’t know what PAIMI has meant to your state you need to find out and then you need to make sure you share that knowledge with both your Senator and your Representative. The mental health bill in the Senate does not include the attack on PAIMI that the House Murphy Bill does and there seems to be little support to change that. Let your Senator know you support him in this. The PAIMI provision is a major source of conflict still in the House. Let your Representative know you consider this a poison pill and ask him not to support any Bill that includes this. It is especially important to let the House leadership know this. Despite Rep Murphy’s pr theatrics there is some evidence to suggest they are less than sold on pushing this Bill forward. Tell them that human rights is not a partisan political issue and that treating those rights as a therapeutic irritant is not one of those evidence based practices Rep. Murphy is so fond of talking about.

PAIMI has played a major role in Tennessee. They not only helped to identify major problems in the adult group home system but were a major part of the attempt to resolve many of those issues. In partnership with the Depth of Mental Health they are a major part of trying to insure that everyone treated within the system is afforded the same protections available to any other citizens.

There is every reason to believe that we can keep the PAIMI provisions of the Murphy Bill from seeing the light of day but the issue is not settled. Your voice matters. Speak loudly…. Speak now. Please.

We need a dream…

April 23, 2016 by

We need a dream
A dream that says
That hate is wrong
That all people deserve
To live
Free from fear
And violence
That none of us
Should be the victim
Of names or labels
That would make us
Less than human
We need a dream
A dream that says
That poverty is not
A disease or
A judgement from
God upon the
Character of the poor
And that even the poor
Should share in the
Opportunities available to
All men
For humanity
Is not measured by
The content of our wallets
Or our social status
We need a dream
A dream that says
No one should die
From the denial of
Medical care
That in a land
That can feed
It’s neighbors
No one should
Go hungry and
That no human being
Should be homeless
We need a dream
A dream that says
Love is stronger
Than hate
That division
Cripples and chains us
And makes us less
Than we can be
And that we will
Never rest
Never stop
Never walk quietly away
When confronted with
Injustice or injury
That the hurt
The pain
The suffering of my neighbor
Is a violation
Of me
What I care about
And the common humanity
Of all people.

The task farce

April 23, 2016 by

Below is the text of a Facebook post by Rep. Harry Brooks  of Knoxville.   It describes the agenda of Speaker Harwell’s task farce(force).

It has been a week filled with long House Floor sessions this week in Nashville. However, we made progress on a few key issues. This week I would like to turn your attention to an announcement made by Speaker of the House, Beth Harwell, and Governor Haslam.
For the past year or so, the Tennessee General Assembly, and Tennesseans as a whole, have heard much discussion over the path for our healthcare system and the issues facing it. As many of you guys know, we had the Insure Tennessee bill last year that failed.  Since then, members of the Tennessee General Assembly have heard from many constituents in regards to this issue. We have realized that there is a healthcare problem amongst many Tennesseans today, and Speaker Harwell’s announcement speaks to that.
The Speaker announced the formation of a Healthcare Task Force for the purpose of improving access to medical care. It has been named the 3-Star Healthy Project. The task force is composed of Representatives Roger Kane, Cameron Sexton, Matthew Hill, and Steve McManus.
The 3-Star Healthy Project’s Task Force will be charged with developing a list of options for making TennCare more efficient and increasing access to medical care for Tennesseans. These options will be tested through a set of pilot programs. One concept under consideration is that the pilots would be launched in different areas of the state and successful pilots would be phased in over time. Staggered implementation would ensure that the rollout of the 3-Star Healthy Project proceeds only after key benchmarks are met. Phased implementation timelines are widely used in quality improvement initiatives currently in the health care sector.  This will allow Tennessee to monitor the success of three pilots to determine which works best for Tennesseans and control costs the most.
Initial discussions among members yielded the following examples of conservative ideas for the pilots: encouraging enrollees to take more responsibility for their health and use of healthcare services; creating Health Savings Accounts funded by enrollees’ premiums to pay copayments for doctor’s visits and prescriptions; providing support for enrollees who want to re-enter the workforce.
Another unique feature of the Project the Task Force will consider is the concept of thresholds and “circuit breakers.” In order for these pilots to be implemented beyond an initial area, costs from the previous phase of implementation could not exceed a predetermined benchmark. The Task Force is charged with identifying such benchmarks, as well as an overall “circuit breaker,” which would immediately end a pilot should the state’s share of costs increase.
The Task Force will evaluate these ideas and others brought to the attention of its members over the next two months. The Speaker has asked the Task Force to return a report to her in June.  They are set to have their first meeting April 26th and 27th.
I hope everyone has had a great week. Please feel free to contact me if you have any questions, or if I can be any help to you. I can be reached by email at or by phone at 615-741-6879. It is an honor to be your representative.

In case there was any doubt this has nothing to do with trying to find a way to find coverage for 280,000 people.   The conservative Tennessee principles she likes to reference are simple….. LET THEM DIE.

Her task force is not about the transformation of Insure Tennessee into something more palatable to their sensitivities.   It is about closing the conversation,  stopping the discussion and talking about something else.

Read again what Rep.  Brooks says,  “Initial discussions among members yielded the following examples of conservative ideas for the pilots: encouraging enrollees to take more responsibility for their health and use of healthcare services; creating Health Savings Accounts funded by enrollees’ premiums to pay copayments for doctor’s visits and prescriptions; providing support for enrollees who want to re-enter the workforce.

This is not just inadequate.   It is fraudulent and criminal.   This is don’t give a damn masquerading as political principles.   This is a small group of people trying to pump a reality as divorced from the real world as possible.

This is trying to shut down a discussion you don’t like and praying that people die fast enough so that no one realizes they still have something to say.

It is the Harwell task farce.

What now?

The living of Cecil Cook…. go rest high

April 23, 2016 by

Cecil Cook was my best and good friend.   He died several years ago and this was written a couple of days after he died.   He was the best person I have ever known and my hope is one day to be half the person he was.   His death was tragic but his living magic.   I still celebrate it.

(Sometimes people ask me what posts on this blog matter to me.   This is my favorite)

You meet very few incredible people in this life.  My good and great friend Cecil Cook was such a person.

They called this afternoon.  He died in a plane crash yesterday.  He was the only one aboard a small plane.  They dont know what happened, dont know when they will.  They said he was literally minutes away from a safe place to land.

Today has been numbness and tears, both without warning, in moments forever, like a terrifying dance. I try to tell myself that he is in a better place and how lucky I was to know him, when so many didnt have the honor, but I feel ripped and torn and life a little less in some important way I dont understand.

Cecil was a good person in a way that goodness really means something.  Kindness was for him not an affectation like it is for some people.  It was not a burden to be endured.  It was not what he tried to be or what he had to be.  It is simply what he was.  It was breath and light and sun.  It made no sense to think of him in any other way.  And with him you knew that kindness was really strength and you found yourself hoping that someone might tell you you were at least a little like Cecil.  He had the unique ability to tell people no matter what their pain, what the circumstances of their life were, that the door to their life was still open.

Cecil was the chaplain at Ft. Sanders in Knoxville.  For 16 years it has been his hospital.  Today I stood in the chaplains space, in the offices, the hallways, and chapel and watched as person after person came to say goodbye or just to come and look and see if it was true.  Some wanted to talk.  Some just stood quietly and cried.  From cafeteria worker to nurse to doctor to administrator they all came.  Their words were simple, “….he was my friend….”  We talked. After a while we just stood.  Then we left.  We had no where to go.  We just didnt know what to do.

But while his death was tragic and the days ahead will seem slow and immobile this is not about his death.  For you see the living of Cecil Cook was the real miracle.  It was the real story. And that is really what I want to share.

We met Cecil about 10 years ago.  My dad was in the hospital dying from cancer.  My wife and I had traveled with 2 of our kids 250 miles to be there.  The kids were 10 and 12 and waiting in the waiting room was no what they can do.  So they got on the elevators and starting riding.  I guess they saw the hospital that day.  I went looking for them, but never came close.  Finally they came in with a smile on their face telling me that we had to meet this guy they had met.  In their rush of words I got he was the chaplain but really didnt understand much else.

I never found out how Cecil knew to rescue them, but somehow he found out and did.  He had told them the story of the prodigal son, but somehow in his version every word started with F.  There were farthings, and fitlings, and friends and fathers and a whole lot of other things that I dont remember.  Cecil recited it for us that day also.  Every word did start with F.  I never found out where he found that story either.  Linda and I walked away that day that day better.  In the short time we knew him we already had a sense that pain was not forever.

We became friends.  And what a friend he was.  He was a confidant, he was a support, he was a teacher.  He helped us to know in his giving that our giving mattered.

Cecil had started the Stephen Minister program at FT. Sanders and in time Linda became a Stephen Minister.  He taught the power of the broken reaching out to the broken.  He believed in the value of ordinary human beings and when he would tell stories of those he ministered to you knew he felt as blessed by them and anything he did for them.  If love is measured by what you give, then Cecil had riches beyond riches.

He loved poetry and he loved words.  It seemed like he had every poem in the world memorized and when the occasion called for it he always seemed to know what verse to recite.  I saw him cry when talking about the pain of others and the illnesses he encountered on a daily basis.  But he could listen and he could care and everyone who met him knew they were cared for.  And they knew that although pain was real and inescapable some times that loneliness was not.  And in Cecil’s heart I think they knew the  reality of the God he served.

After years of tagging along with Linda and being an unofficial Stephen Minister I decided to finally take the training and become official.  Our class, Cecil’s last, has just started.  The training will continue and I hope to graduate.  But I will sorely miss him not being there to congratulate me.  He so much shared joy you didnt feel like it was a hard thing to find and right now I wish I knew where to look.

Cecil I think is in a better place and Heaven is a brighter and even cheerier place this night.  I really wish you could have known him.  He was a friend, a colleague, a model, a teacher and I dont know how many other things.  Somehow I always had the feeling he could help regardless of how bad things were.  God is a God of miracles or how else could there be a Cecil.  It was an honor to know Cecil, but you know, I really think he felt like it was an honor to know me.

I dont know how to end.  I dont know if I want to.  The night ahead and days to follow already seem long.  I saw Cecil do a funeral once.  He  turned to the audience and said, “Lets talk about her living…”  It seemed like such a good way to say goodbye.  Good bye Cecil.  I dont know where we would be without you.  You have touched so many in so many ways and I hope when you look down you see in our living a small token of how much you have meant to all of us.

On what we cherish….. when easy just seems very hard

April 23, 2016 by

I found the post below on Facebook memories.   I don’t even know how long ago I wrote it.   Sometimes I post things to certain people.   An answer to a question,  a message,  sometimes support.   I  always hope a lot of people read but sometimes it is just about what one person reads,  one person hears.

The post below is really for me.   There is a line in a song that describes a lot about how I feel right now,  “Easy is getting harder every day…”  

It was originally written for a friend. He was trying to cope with a major tragedy in his life.  I remember telling him the loss of important things need not be the end of finding things important.  

This post is both reminder and prayer for me.   If easy is getting hard for you I hope you will find something in it for you.

I know people that life is not going to change for.  An accident of birth, a victim of circumstances, bad luck….a hundred thousand million different reasons.  Everyday is weight. 

People can not always choose what they live with.  Perhaps the answer is in what we live for.  Perhaps we can in some way choose what we cherish.  Maybe when we cant make things different we can still find a difference.

Do hard things, even very hard things, have to matter as much as good things.  Do loud things make it impossible to hear other things?  Do you sometimes even wonder if there are other things?

Perhaps that is where the journey starts- in knowing there are other things.  In knowing that the loss of something loved need not be the end of loving.  Perhaps that is where the seeds of hope can be found.

I had a great and good friend named Cecil Cook who died in a plane crash several years ago (see “The living of Cecil Cook”).   He was the most helpful person with hurting people I have ever known.  He knew a truth very few people ever knew: that kindness was the greatest strength.  It was like breath to him.  I remember once at a funeral he preached he said, “Lets talk about how she lived…”  And for 30 minutes we told stories and laughed and then cried and then told more stories.

Sometimes we have the wrong conversation with ourselves.  I know I do.  This is a brutal period of my life and sometimes at night sitting on my porch I wonder about kinder spaces and better times.  We all suffer small deaths every day but perhaps the conversation should be about how we have lived.

The deepest injury is not in pain or hard times.  Perhaps it is not even in loss or sorrow, not even in the loss of what we cherished, but in the awful soul killing fear that it doesnt matter what we cherish, what we love, what we care about.  Perhaps that is the injury unto death.

Remember Cecil’s words.  “Lets talk about how she lived…”  Give yourself the same gift.

The myth of the abduction of psychiatric care

April 22, 2016 by

There is a widespread myth that for many people is accepted as automatic truth. Psychiatric care, in a real way, according to them, has been abducted by the actions of unscrupulous people who care nothing about the most vulnerable amongst us. Their actions are borne of selfish motives that seek to benefit themselves at the expense of the needs and welfare of the “severely mentally ill” It is a destructive myth to the degree it drives many people’s call for mental health reform in a direction that only makes things worse for the people they claim they want to help.  

The post linked above is only one example of an appeal to that myth that would have to back to a system that we largely junked because it was abusive and hurtful to many of the people it served.  It was a financial monster gorging itself on the resources of many mental health systems and making it impossible for them to develop alternative services.  

But most of all it didn’t work.   It didn’t offer people a better life.   It didn’t offer resolution of critical life issues.   It told people that hope was an illusion for them,  that misery was the most realistic option for their life and they would help them manage that misery.   It gave them a diagnosis that would follow them forever that their own studies show had little validity or reliability.  It gave them medicine that frequently didn’t work and when it did they largely didn’t know why.  It gave them medicine that for many had life threatening or life altering effects. It cost many people years of their lives. It provided the apology for a culture that belittled and shamed the “mentally ill.” “Mental illness” was for many the definition of their life. They were often poor, often hungry, too often either homeless or in jail, lacked any access to decent health care and that is only scratching the service. The injustices, the hurt, the trauma of their lives were explained away or justified by reference to their “illness”. The injustice in their life according to the psychiatric vision was a consequence of their illness and psychiatry in some ways became an apologist to the worst of our culture. For many the reality of their experience was much more assault than illness.

The myth has some differences or variations depending upon who explains it. It is the foundational myth of the Murphy Bill. It is the pillar everything else rests on.

It goes something like this :

Psychiatric care has been abducted. It has been stolen. The treatment based on sound medical truths so essential to the lives and welfare of so many poor suffering people with severe mental illness is no longer available to them because it has been marginalized by people who have a vested interest in the notion of recovery and these people are willing to abandon and hurt those in the greatest need to feather their wallets and their ambitions.

Some versions of the myth are not quite this blunt and make some effort to blunt the paranoid or conspiracy theory quality of it but the message is clear. The people who should be in charge are no longer in charge and until we make things right the mental health system will never be what it should be.

There are a lot of ways to question this myth and many justified criticisms that can be made. I want to look just at one phrase….. the psychiatric treatment of severe mental illness. The reality of it has little to do with the romanticized “Hollywood like” notion of it.

Before I go farther a note on language. Despite what they say about ground breaking treatments and evidence based treatment I understand the term psychiatric treatment in this context to largely be psychiatric hospitalization and medication…. neither particularly new or evidence based.

1. Psychiatric treatment (at least in terms of hospitalization) has remarkably little to do with psychiatrists. Psychiatrists, in a very real way, exist to sign off on the work others do so the insurance companies will pay. I know of one psychiatrist who had 60 patients in one hospital. He got paid a $100 a day attending fee for each one of them. 3 hours of every day were those patients being lined up outside his office to be asked the same 3 questions: Are you sleeping? Are you eating? Do you feel like hurting yourself? Then he would dictate a note about the progress of their depression.

2. If you go to a psychiatric hospital the first thing you learn is that it is about power. You have none and life on the ward is about how you navigate the power above anything. The first sign a patient is making progress is that they don’t make trouble and how not to make trouble is the first lesson learned by most patients.

3. The course and length of your treatment is not defined by the progress of your mental health but by the willingness of your insurance company to pay for it. As long as they are willing for you to be there the people there will have no trouble finding something for you to work on.

4. Psychiatric hospitals don’t treat mental illness. Before you have a heart attack let me explain what I mean. Nothing is tailored to you because of your diagnosis. There is no diagnosis specific treatment. Everyone is offered the same cookie cutter, generic program. For many hospitals it is groups teaching the same prepackaged skills in the same way. If you “relapse” you get to do the same groups again.

5. The most predictable experience in any psychiatric hospital is boredom. For many hospitals therapeutic millieu is little more than sitting in the day room watching TV. But rather you watch TV or not long periods of having absolutely nothing to do are characteristic of a large amount of hospital programs.

6. Psychiatric hospitals thrive on the dependence of the people they serve. Particularly for profit hospitals survive in a big way on the return business of those they have previously served. The message is clear… this is a long term thing and you will likely need to see us again. It is much easier to get somebody to come back for a second visit than it is a first one.

7. People who work in psychiatric hospitals want to help the people the people they serve but psychiatric hospitals don’t admit people because they can help them. They admit them because they can get paid for them. There is no such thing as refusing admittance to someone they think they cant help if they know they can get paid.

8. There is perhaps some evidence that psychiatric hospitalization is an evidence based practice. I just have never seen it or heard about it.

9. Psychiatric hospitals did not fade because of some evil conspiracy. Too little bang for way too many bucks. It really is that simple.

10. Other than perhaps some psychiatrists I know of very little mental health professionals who believe hospitalization matters. Some see it as an important source for a temporary safe space for someone in need of a safe space but that is the limit. Again it is not a conspiracy. Just very few people drink the kool-aid any more.

11. For most states I know anything about increased psychiatric hospitalization is just not a real financial option. That ship has sailed and isn’t coming back.

12. The psychiatric role in the current system is to prescribe meds and sign off on the medical necessity of other people’s work. The idea we need to rely more on psychiatric input neither reflects the reality of the modern system or even the number of available psychiatrists.

Everyone wants a bigger piece of the pie and everyone wants to protect the piece they have. The romanticized notion of psychiatrist as healer and leader of the mental health system is simply an attempt to protect and enlarge a piece of pie. The reality of psychiatric care doesn’t come close to the version many would try to sell us.

A Handful Of Doctors Are Working To Revolutionize How We Think About Self-Harm

April 22, 2016 by

The Murphy Commandment….

April 22, 2016 by

Tim Murphy has done as good a job as I have ever seen in painting himself a brave warrior,  a ferocious fighter for a holy cause.   It was hard at some point in this to not believe he was an irresistible  force destined for certain victory.

But it’s the House of Representatives.   The quicksand of irresistible victors.   They can’t pass a budget.   They are chronically allergic to agreement.   They are the only legislative body alive keeping the Tennessee General Assembly from winning the gold medal as the most pathetic legislative body in the United States.  The big policy news this morning is that one of their members who always liked Target because he didn’t have to walk to the back of the store to use the bathroom is now boycotting them because of their recognition of transsexuals as people too.

Rep.  Murphy has never realized that his bill would never see the light of day as the Murphy Commandment.   As logically contradictory as it is for him he has to craft an agreement.   So far he hasn’t shown he can.   The IMD exclusion repeal is not flying in the current budget asylum that is the House.   Much that had been divinely imparted to him will not fly in the Senate.   And I have such a hard time seeing Barack Obama add this to his legacy as he leaves the White House.

Rep Murphy can pitch a tantrum and say my way or no way.   He has basically been doing that for a couple of years.   But in the end I believe there is no mountaintop.   There are no tablets.   And barring a major miracle there will be no Commandment… Murphy or otherwise.

(This is probably an inappropriate way to end this post…. I have an image in my head of Rep Murphy  on the mountaintop with Moses red faced,  stomping his feat loudly,  madder than the dickens pointing his finger in Moses face screaming…. “Oh yes you will. Yes you will….”)

Seriously I have begun to believe nothing is happening this year in mental health reform. I hear Democrats are considering trying to get gun control in the Senate version and they can’t find the money to repeal the IMD exclusion either. In the House Murphy has Murphy. Nothing is going to happen in an election year that in the end anyone wants to take credit for.

That’s what I think. Take it with a grain of salt. The quickest way I know to make anything happen is predict it won’t. I guess we will see.

The bathroom bill….

April 22, 2016 by

I remember many years ago talking to a young child…. I think he was 5 or 6…about personal safety .  He told me not to worry.  He knew who was dangerous and who was not.   His mother had told him.   I asked him what you did to be safe and he told me it was simple.   “Look at their heads…..”

I asked him what he was talking about and he turned and smiled at me.   “My momma told me anyone who would hurt a little kid had to be cracked in the head….”   (He was looking for the cracks.   That was his safety plan)

Today we have a new version of the cracked had…. Transsexuals in the bathroom with little girls.   I think the data would probably show that as many transsexuals have attacked little girls in the bathroom as people with cracked heads have.

Politicians looking desperately for a hate that sticks have flooded the country with bathroom bills that make where you go pee potentially a criminal offense.   In Tennessee one of the cosponsors of our bathroom bill has his office moved out of the legislative plaza after a special legislative committee decided that based on his normal behavior it was dangerous for him to be allowed access to women who worked in the legislature.

Scores and scores of organizations and businesses and people have pointed out that this is discrimination, hatred, and violates most of the laws in this country. There is, despite what Republican presidential candidates, say no right to legalized bigotry.

But I want to make another point.. a very personal point. These laws do not make children more safe. They make them less safe. They tell kids that danger is about people who look different, that nobody who is like them could possibly be dangerous. They tell them who to be afraid of and tell them the people you are afraid of is where the danger in life is.

It is a lie. It is a huge mountain of a lie. Anyone who has had personal experience or anyone who has worked with victims will tell you the most dangerous people are the ones who don’t look at first dangerous.

When I was a kid I knew to look out for weird or strange people. I knew I was safe.

When I was 13 years old I was sexually abused. It went on for 8 months. He didn’t look strange. He didn’t act strange. He was my pediatrician. I would stake everything I know now that I was neither the first or the last. He didn’t have a cracked head nor was he trolling the bathroom looking for kids. In every way he appeared to be everything that a trusted, respected person should be and he was a monster.

There are all kinds of opportunists but I think the worst are those who would tell us that we should hate and fear those not like us and then they ride our hatred and fear for personal gain. It is lower than a snakes belly behavior.

I am not afraid of people with cracked heads. I fear most those with stone and hard hearts who would tell us hatred and fear are the most American of values instead of a betrayal of what this country is about.

They are the ones we need protection from.

A guide to messing up

April 21, 2016 by

If you are like me you mess up a lot. Part of the problem for me is that too often I don’t always have a good sense of where or how I mess up. You get used to doing things the same way. It becomes “normal” and all other things being equal we tend to do what is “normal.” Messups acquire a life of their own. They become what we do without even thinking about it. They become part of us. At their worst we come to believe they are us.

What follows below comes in part from my effort to become a “more sighted” person. It stems from a hope that if I see better I will do better. You will have to decide if it is even a little bit of a help for you.

The guide described below is a progression through a series of questions. I don’t think any of these questions are particularly original to me. I have used different versions of these questions in the past.

I am not saying to reason or make decisions by a checklist. If you can do that you have skills I don’t have. My hope though is not in any specific decision but to get better at deciding and perhaps these questions might help there.

1. What….

What is going on?

What are the facts?

(How often do you jump into a situation without even knowing what is going on. How often is your “knowledge” fragmentary at best or distorted at worse? How often are your immediate reactions more a reflection of who you are rather than a reflection of what is really going on? At times, depending on the issue or circumstances, all of these things are major problems for me.)

2. So what…..

What is the problem?

What kind of damage has been  done to who?

(What is the problem with what is going on? What are the impacts? Who or what is damaged and how? Do you misidentify the problem? Do you make it bigger than it is, make it more long lasting than it is, or make almost all problems about you even when they are not? Or on the other hand do you minimize or downplay things because conflict or issues make more of problem than you want to deal with? Virtually everyone I know has a problem of some degree or other with this.)

What is likely to happen? Where is the situation going? What is the most reasonable expectation to base your behavior on?

(How often do your expectations just miss the boat? How often do you just not see things coming? How insightful are you not?)

What resources,  abilities,  or support do I have?

(How often do you decide to do something you just can’t do? You lack the skills, the resources or tools, the support and motivation to make it happen. How often does your sense of want to do not match the reality of can do? On the other hand how often do you back away from something you can do because you assume you can’t?)

What are my priorities?   How much attention and energy can I give this?

(Does my use of time and energy reflect what is important and essential to me? Do I make wise choices about what I can do, what I want to do and what I need to do?)

3. Now what…..

What do I want to do?

What is the plan?

(Do you know what you want to do and does your plan give you a realistic chance of success? How often does your behavior not reflect what you would like to see happen? How often do you not make a plan at all and just blindly act out?)

4. Now….

Take action.   Carry through and implement plan.

(How often does your behavior not reflect what you plan to do? How often do you simply not carry through with things you planned to do?)

4. What now….

How is it working?

What do I need to keep doing?

What do I need to change?

(How often do you just keep doing the same thing whether or not it is working? How often do you even pay attention to whether or not something is working out? Do you learn from experience or just keep on doing the same old things?)

In some ways this post is a glossary of human frailties. It certainly describes a lot of mine. In some ways most of us limit ourselves in ways we don’t have to. It does not by any stretch of the imagination mean this is all we are about. Sometimes life is extraordinarily hard but sometimes we are extraordinarily hard. I hope in these questions you see an inkling of some ways you can be kinder to yourself.

We are all distressingly human at the most inconvenient times.

My mother….

April 20, 2016 by

My mother died many years ago.. way too young.   She adored my older son but never got to see him grow up.   My two younger ones never got a real chance to know her.   I think they would adored her.

I was living away when she got really sick.   She had cancer but never really talked about it a lot and I remember how surprised I was when I saw how bad it was.  It is just a word till you saw how cruel it was.

I was there when she died and I remember how she struggled even for her last breath.   And I remember feeling glad she wouldn’t hurt anymore but knowing at the same time life was forever changed and something so crucial lost and gone.

My mother died with dignity but I think it was because she never stopped living with it.   She made a conscious and intentional decision to end well.   She didn’t want anything left undone.   She said her good byes.  She mended all the fences she could.  She made sure she left no thank you unsaid.

My mother’s dying was never really about her death.   It was about her living.  It was about her life.

I have written about some version of that lesson in much that I have written and I owe the teaching to her.   You can’t always control what you have but you have some decision about what it is about,  what it means.

I know some very courageous people right now.  I marvel at their ability to make the worst of things still about life. I am astounded when I see people take the worst of things and not treat it as the verdict of life but as a question about how to live.

The last couple of weeks have been lousy for me. Linda is struggling really hard right now. We are apart way too much and her pain is torture to me. Helplessness is not a graceful thing for me. The out of the blue execution of Insure Tennessee by the Tennessee General Assembly has left me gasping for breath. I know people who can’t wait. I know people who will be left behind and I simply didn’t know it was possible for me to be this mad.

I ashamed to say I don’t think that much about my mother any more but I have thought a lot tonight about her lessons and living even in the hardest of times.

This time will end because all times end. Nothing is everything and always no matter how much it feels that way. In the end it is about the living you want to be yours even when the life given is not.

It is a time of great sadness for me and perhaps rage is a temporary way to blunt the worst of it. I hear my mother tonight. “It is still about the living…”

And it is. If you are a praying person we could use some prayers. As always your support and encouragement means a lot. If my anger and rage has seemed at times consuming and uncomfortable for you I apologize for that. Thank you for listening.

And thank you for letting me talk about my mother. Maybe in some way she speaks to us all.


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