The current debate about bringing back mental asylums made me wonder what Virgil Stucker, the founding executive director and president of the CooperRiis Healing Community in North Carolina might think. He was kind enough to offer his thoughts.
Think of the Modern Asylum as a ‘Recovery College’
By Virgil Stucker
The notion of ‘bringing back the asylum’ for individuals with overwhelming mental health challenges has been stirring debate. There are multiple points of contention, some of which lead us down unproductive and confused paths. We rightly bristle when we think of the abuse that the asylums of old caused. Let’s hit the pause button and acknowledge that none of us seeks to bring back those abusive systems.
We also bristle at the notion of Dr. Ezekiel Emanuel who seems to think that as many as 500,000 in the US are mentally broken and simply need humane, permanent containment. What I hear him saying is that no matter what we do, some of society’s most vulnerable appear unable to conduct their lives successfully on their own. This may be true for ‘some’ but not for 500,000. Nor should we assume that permanent containment and separation from society should be the starting point for anyone.
All of us also agree that we should do better than simply containing our most vulnerable in prison and jails (about 600,000 with mental health diagnoses). Also none of us thinks that it is OK simply to allow them to roam the streets or simply to chemically contain them via the overuse of medications. We continue to hope that we can develop and improve systems that will help our most vulnerable to recover their capacities for independent and successful living.
What can we learn from the early asylums as we seek today’s solutions? In the late 1700’s and early 1800’s these small healing communities were where some of society’s best minds tried to improve the lives of emotionally and mentally overwhelmed people through ‘moral treatment’. (http://en.wikipedia.org/wiki/Moral_treatment) I looked at one closely as I was preparing to offer a staff training at Friends Hospital in Philadelphia. We found some surprising and positive outcomes data from 1825 when it was still the Friends Asylum.
| Outcomes Data: From the opening of the Asylum, in May, 1817, to the month of March, 1825, the number of patients at the Friends Asylum admitted was: | 158 | ||||
| During these 8 years 64.5% returned to the community | 1) Recovered | 53 | |||
| 2) Much improved | 23 | ||||
| 3) Improved | 17 | ||||
| 4) Without apparent change | 9 | ||||
| 5) Died (13%) | 21 | ||||
| 6) Remained in the house (22%) | 35 | ||||
| 158 | |||||
| Average annual number of patients during 8 years (daily census) | 19 ¾ | ||||
(Account by Robert Waln 1825: http://collections.nlm.nih.gov/catalog/nlm:nlmuid-68141100R-bk )
Unfortunately, by the mid-1800’s, these sanctuaries with their balance of milieu therapy and ‘modern’ medicine (at that time) were being lost. They were exploding in size, became underfunded, lost their values, and were poorly led. They imploded. Today, the word ASYLUM in relation to mental health care is experienced as a pejorative term.
In the wake of the implosion, we were influenced by economic pressure and inspired by hope that modern science could discover quick cures for madness. Mental health care moved toward acute care, stabilization, and quick release from hospitals back into society.
Unfortunately, the milieu within society is generally not a “humane and caring social environment”. In society and in most mental health systems, we have lost the balance between milieu and medicine. It is not that we are relying on medicine too much; it’s that we are not generally providing it within an overarching “humane and caring social environment”. Medicine, too, can be driven to excess, such as with the overuse of medications, when it is practiced in isolation,
We are grappling today for new solutions and new balance, drawing from constructs of the past while reaching to the future. The starting point is that we all wish somehow to improve society’s systems of mental health care and perhaps even add new structures to those systems.
Our shared mission is to help society’s most vulnerable to achieve and sustain their highest levels of functioning and fulfillment in the most cost effective ways. Of course, a wide range of options should be available for individuals who may be overwhelmed by mental health challenges. Of course, individual choices and needs should trump ideology. We know that the mental health field is filled with voices that too frequently sound like debates between atheists and fundamentalists who do not listen to one another.
Since 1975 my life has been entwined with the mental health field, helping to launch, lead and guide residential healing communities. First, I observe that when one has succumbed to emotional despair, one’s community is generally the best place for healing to occur. (At least it should be.) Sometimes, however, the fractures in the person’s relationships can be so significant that one’s local community is unwelcoming or unhelpful for myriad reasons. Acute fractures can call for hospitalization. Persisting fractures raise the question: Where can I go for healing?
Sometimes, when we want to learn how best to deal with life’s challenges, we go away to college. Anthropologists have helped us to understand and value ‘liminality’ as that place and space that is ‘betwixt and between’. The liminal college experience, for example, helps us to pass from adolescence to adulthood with both social and career skills.
With this concept in mind, I propose that we consider how ‘residential recovery colleges’ for old and young alike might provide a means of passage for individuals from their state of being overwhelmed to a state of being able to achieve and sustain their highest level of functioning and fulfillment. One would move through these ‘recovery colleges’ which would include a system of care that also provides support for community re-integration. Some would move through in a matter of months; some might take a few years.
Cost? On the front-end, these recovery colleges would require capital investment, probably at lower levels than the cost for new prisons or state hospitals. The returns of investment for the recovery colleges, would, however, be far superior to those of prisons or of most state hospitals. (I say ‘most state hospitals’ because my experience of providing brief training for Dr. Jeffrey Geller’s team at the Worcester Recovery Center – an emerging ‘recovery college’/state hospital – shows how this concept is already emerging in the public arena.)
Return on investment? The ‘graduates’ of these recovery colleges will have learned both skills and resilience and will be more likely to live more fulfilled and functional lives which will be less costly to society than the current chronic disease models with their chronic costs.
I know this to be true from my experience and our accompanying research at our CooperRiis Healing Community. (www.CooperRiis.org) My history within this healing and recovery community movement began in 1975 at Gould Farm in Massachusetts, which has been a nurturing milieu for those with mental health conditions for over 100 years. After 14 years, my family and I set out to replicate the model; I was the founding Executive Director of Gateway in Richmond VA, of Rose Hill in MI and of the CooperRiis Healing Community in North Carolina, which was launched 12 years ago via the philanthropic leadership of Don and Lisbeth Cooper. (All of these initiatives have been nonprofit.)
In our work, we, too, have tried to re-optimize the mix of medicine and milieu. Oliver Sacks wrote in the NY Review of Books in 2009 that we were trying to ‘Restore the Lost Virtues of the Asylum’ (http://www.nybooks.com/articles/archives/2009/sep/24/the-lost-virtues-of-the-asylum/ )while providing the opportunities of modern medicine. A couple of decades ago, those of us in the field also helped to form www.ARTAusa.org, a consortium of 32 residential healing communities. All of these provide recovery-oriented, humane and caring social environments for people who are leaving acute care and seeking more functional and fulfilling lives.
CooperRiis may have some elements that are more like the early asylums but I would no longer use that word ‘asylum’. I am proposing that we examine how ‘recovery colleges’ might better meet the needs before us, not as places for the permanent care of 500,000, but as places through which the 500,000 might pass on their way to improved lives.
Our experience at CooperRiis is far from perfect but we have had some successes with over 800 very troubled and vulnerable individuals passing through our healing community toward improved lives. We see ourselves as a healing community which has restored the virtues of compassionate, comprehensive care balanced with the best of modern psychiatry, psychology and science. Our residents are often with us 6 months to two years. Most recover and move into meaningful lives, no longer as impeded by their mental health condition. (Some of our CooperRiis research is found here: http://www.cooperriis.org/forms/2013_outcomes_summary.pdf More is available.)
My hope is that my words will add to a productive dialogue rather than to a debate. I think there is middle ground, productive space, where neither the atheists nor the fundamentalists win. A space where we keep our ears open and listen to and help guide the vulnerable who walk with us. After all of these centuries, we are still not done yet…
Virgil Stucker, founding Chairman and President of the Foundation for Excellence in Mental Health Care and current and founding Executive Director and President of CooperRiis Healing Community, has integrated his life with therapeutic communities since 1975 when he first started at Gould Farm, America’s oldest therapeutic community for individuals recovering from mental illness. Gould Farm, founded in 1913 in Massachusetts, is one of the models CooperRiis has followed.
Virgil felt destined to help create therapeutic communities; after 14 years at Gould Farm, he was the founding Executive Director of Rose Hill in Michigan which opened in 1992 and of Gateway Homes of Richmond, Virginia which opened in 1986. In 1978 he was the founding Program Director of Gould Farm’s Boston Program.
Virgil also took some “sabbaticals” (as he puts it) from the life of therapeutic community, each of which further explored his interest in community and the power of relationships. In Massachusetts; he is past founding president of the REACH Community Health Foundation, Vice President of Planning and Development for Northern Berkshire Health Systems, President of the Berkshire Taconic Community Foundation, Senior Vice President of Legacy Banks, a community banking system, and Adjunct Professor of Philanthropy for the Visionaries Institute of Suffolk University. His degrees include an MBA with a focus on non-profit creation and management and a BA in philosophy. He graduated Phi Beta Kappa.
In addition to their personal involvement with therapeutic communities, Virgil and his wife Lis share their lives with their four children, two daughters-in-law, one son-in-law and seven grandchildren.
He has also served on 11 nonprofit boards and is an avid musician, playing mostly Native American flutes.
Virgil Stucker, (828) 899 4673, Virgil@CooperRiis.org
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