Vaughn's space

Oh, the French: they can create such a dustup over things mixing art and politics, and, yes, France is a culture that is inclined to mix art and politics, one being as important as the other in that culture. This time they are heatedly debating whether the remains of Albert Camus should be moved from their resting place to the Pantheon, where the French inter their most honored dead. The Pantheon is a basilica-like structure that houses the remains of Voltaire, Rousseau, Victor Hugo, Andre Malreaux, Emile Zola, Madame Curie, Pasteur, and one of my favorites, Jean Moulin, a French resistance leader who was betrayed and murdered because of his powerful counter to the Nazis.

 

Camus is one of my personal heroes. If you are not familiar, he grew up impoverished in French Algeria. He suffered from TB at a time when its sufferers had to withdraw from living with the rest of us, from time to time, to care for a flareup of the infectious disease. It's hard to imagine such a social being as Camus -- the man of French cafe society -- isolated for even a day, let alone weeks and months. Throughout his life, he bucked the pain of disease and the dismissal of a stratified French culture to become a powerful and profoundly moral voice. As the editor of "Combat," the underground newspaper of the French Resistance, he risked execution by the Nazis, and he lost one of his closest friends to the noose of the Nazi henchmen. Camus was fearless. He knew that freedom and individuality did not come without a price, and he was willing to pay it. Read his essay, "The Myth of Sysyphus," to understand the virtue and liberation he saw in the defiance of life's harshest conditions. He was also fearless in the face of the likes of Jean Paul Sartre and a group of the French literati who would try to destroy Camus because he warned that Communism held the threat of totalitarianism and ruthless oppression. Camus was right; they were wrong, but being right did not keep him from having to fight for his literary and social reputation. He would win a most deserved Nobel Prize for literature, this man who struggled up from poverty against elitism, disease and the genocidal Nazis. On the day Paris was liberated in 1944, his editorial in the Resistance newspaper "Combat" concluded that the most magnificent and redeeming quality of human beings is their determination to be stronger than their condition. He wrote this after years of war that made many question their belief in the existence of God.

 

What has prompted the move to exhume Camus' remains and carry them ceremoniously to the Pantheon is the fact that he was killed 50 years ago, as of January next year, in an auto accident. He was 46. Coincidentally, 1960 was the year John F. Kennedy was elected President of the United States. He would be assassinated on this day in 1963 at the age of 46. I have been to the Eternal Flame over JFK's grave, and I have been to the Pantheon, to feel the presence of Voltaire, Rousseau, Curie, Pasteur and Moulin. I have wondered, during my several vistis to the Pantheon, why Camus is not there. The resistance to moving him there apparently comes as a result of accusations that the French president, Sarkozy, is trying to make poltical hay for himself by moving Camus to a hallowed place under the dome of the Pantheon. Get a grip, everybody. Camus was, is, a monumental presence in our world, whether resting in the Pantheon or in an obscure grave. My personal opinion is that he should be moved to the Pantheon. Should he be moved there, I will book yet another trip to Paris, a place that I love, but a place I love because it endeavors to honor those who have shown individuality and moral courage in the face of what would extinguish it.  

 

 

 

It is a perfect Autumn day here on the Wasatch Front. The temperature is so delicately balanced between seasons that the temperature switches from comfortably warm to nippy with the gentle swelling of a breeze. In one of those swells, golden yellow leaves fall like a flurry of snowflakes from the beech tree that towers over my home and back yard. The jagged leaves carpet grass still green. The season is changing, and the change is comforting, not jarring.

 

Comforting, not jarring: I can say the same for the change I just made, moving from one position to another, leaving a community mental health center that is in upheaval, its first tremors rippling through the staff in the days as I was exiting. My change has been gentle; my former colleagues' change will apparently not be. The organization's executive management just announced that as many as 125 workers will be laid off. Who, specifically, will be laid off will not be known until word comes down in December. I feel for my colleagues there. Their work is not easy; it is very stressful; a few of them are in excellent physical condition as far as the eye can see and yet still have high blood pressure and high cholesterol; one of them is a distance runner. What would explain the seeming discrepancy between being slim and fit and yet having high blood pressure and high cholesterol? My suspicion has always been stress. The unit manager where I worked, a man I respect, told me once that working in an outpatient unit of a community mental health system is not for the "faint of heart." He knows of where he speaks; he's been working in community mental health for more than 40 years. You can't appreciate the stress until you find yourself responsible for a caseload of 125 or 150 people, most of them persistently and severely mentally ill. You do what you can to relieve and keep them safe from psychiatric symptoms that threaten to debilitate them and sometimes lead them to take their own lives. 

 

In that context, you work as a clinician to help clients function independently and to find quality in their lives despite the restrictions of severe mental illness. And, yes, that can be, and is, done. My experience with clients in community mental health leads me to say that individual psychotherapy is where the base is laid for improved life quality among these clients. An old saying applies: Give a person a fish, and he or she is fed for a day; teach them to fish, and they feed themselves for a lifetime. That's what psychotherapy can do: teach clients to nourish themselves, even from waters that would seem unproductive.

 

And yet, the community mental health center I left a few weeks ago proposes a treatment model that, as I understand it, views individual psychotherapy as being of marginal value. It favors a case management approach that would lead to a greater supporting eco-structure for the clients while calling this approach "person-centered." It seems a contradiction to call this approach "person-centered," given that it calls for case managers or "care managers" to aggressively oversee the lives of clients rather then let them learn to live on their own, as good psychotherapy is designed to do. The persistently and chronically mentally ill live at the lowest socio-economic level. For many, the suffering of mental illness is compounded secondarily by shame over their social and financial conditions. To be heard as a unique individual in individual therapy is essential to the effective treatment of a client who is chronically mentally ill and who questions his or her uniqueness and worth because of it. Word is that psychotherapists will bear the greatest brunt of the layoffs, and that group therapy will replace individual therapy.

 

As for myself, my change has been good. I work for a health care organization that is today featured in a lengthy New York Times Sunday Magazine article as a model for improving health care. So far, my new job has provided chances throughout the day to surface and take a periscope reading of what I am doing, including in my overall life. My former job seldom permitted that; I saw clients back to back in individual therapy throughout the day. I hope they always knew that I was focused on them, whatever my stress. They are deserving of that one hour to themselves. And I hope the work of my colleagues who provide it will be respected. I also hope that all of them, colleagues and former clients alike, are seeing the colors of fall and the crisp creases of the mountains around us in the way I am seeing them today.  

 

 

 

 

 

I grew up in a leafy Pennsylvania town where, history records, Thomas Paine, the fiery revolutionary writer, wrote his combustible work, "Common Sense." He was an incendiary force, driven by perhaps the most bold philosophical initiative ever conceived by human beings; that is, the American Democracy. In junior high and then high school, and on many other days outside of schooling, I walked past the grave of James Smith, one of the signers of the Declaration. Questioning is in my blood and my cultural heritage; I just can't turn it off. For years, I was a journalist, and now I am a mental health therapist. The two are intertwined, though that is a discussion for another time. Still, I am of late questioning why there is such superficial reporting by reporters covering mental health. Yet, even as I say that, I realize I am not commenting on the national scene, where reporters/writers like Andrew Solomon win, as he did, prizes like the National Book Award for reporting and writing so incisively on matters of mental health. Read "Noonday Demon: an Atlas of Depression." And yet, locally, there appears to be so little caring or depth in reporting on events that affect the mentally ill. There are exceptions, no doubt. But nearly 40 years after the Kennedy Administration made a bold stroke to deinstitutionalize the mentally ill and give them as much quality of life as possible under the Community Mental Health Act, I am seeing neglect, not only on the part of politicians, as can be expected, but astonishingly by the press. Which brings me back to the topic of questioning: questioning should be in the journalist's DNA. And, yet, there are instances that come to mind, of late, when reporters simply print what community mental health administrators say, and then call it a day. Perhaps no other sector needs vigilant reporting like community mental health. The most vulnerable of the vulnerable are subject to the care of the many understaffed community mental health centers of this country. For the sake of proper care, and for the sake of wisely spending taxpayers' dollars, there is a need for first-rate vigilant reporting on community mental health., its business and clinical transactions and the quality of both. I would be willing to donate money for a nationally recognized award that provided incentive for good reporting at the local level in this area. Enough said for now. Though, I'm sure, Thomas Paine would not leave it at that.

They seemed to be traveling south early, the flight of geese I saw through the high, floor to ceiling windows of my office yesterday morning. They appeared about the time my first client of the day was recounting how her daughter nearly died recently from bingeing on alcohol and Xanax. Her daughter told her she was not attempting suicide, that she just wanted to blot out the world, so great was her psychic pain. My attention was split, listening to a story of despair and a person's desperate attempt to escape it while drawn and exhilarated by the long dark strand of geese, advancing elegantly, straight as a pencil line against blue sky, across a continent and toward a warmer season of life. They sometimes exhaust themselves in their journey, their bodies giving out, their will still determined when the last breath comes. I learned this in my mid-teens after finding a Canada Goose lying dead along the Susquehanna River in Pennsylvania, its wings spread and its webbed feet trailing behind, its long neck stretched before it, as if still in flight, still destined for a far place. Much later in life I learned that geese mate for life. That lesson was learned while facilitating grief groups for the university where I worked. As a poignant illustration of grief, I would tell my group that if its mate is lost in the flight, a goose will go in search of it, searching sometimes until it too exhausts itself and dies. The point is furthered by the understanding that grief, too, must exhaust itself. No goose fell from the morning sky during my brief glimpse of their beautiful, confident and determined act of life. In that moment, my thoughts and emotions lightened and took flight. If the client before me had been new, if I hadn't worked with her for some time and developed a trusting relationship in which she would properly understand, I wouldn't have alerted her to the scene. But I know her strength, and she knows by now my unwavering empathy and regard for her. A decent interval had passed between her daughter's crisis and our discussion of it in session. I asked her to take a look, so she could know that my visibly divided attention was not caused by anything mundane. I took the chance that what had taken flight in me would take flight in her: hope, determination and an awe of life and of the elegant flyers who inspire such heart-lifting thoughts as no therapist ever will. I hope it worked. I hope it lasts.