‘Lean on me, when you’re not strong, and I’ll be your friend, I’ll help you carry on…For it won’t be long, ‘til I’m gonna need somebody to lean on.’ ~ Bill Withers.

My professional introduction to mental health began in nursing school.  I was assigned to an inpatient facility which was housed in a beautiful old English home.  I don’t know the history of the place, but it was no ordinary family home.  It was on a large estate with well-tended gardens.  The routine was so different from the hospital next door.  Here the patients dressed in regular clothes, as did the nursing staff, so if you didn’t know, you could be fooled as to who was patient and who was the nurse! 

There was one nurse in particular, that the students whispered about, for she could be seen sitting by herself, talking to herself.  Since this was way before cell phones and hidden earbuds had been invented, she definitely was holding a one-on-one conversation with herself.  She was close to retirement and was usually assigned one task, to escort patients who were in their manic phase, for she would stick to them like glue and make sure no harm came to them.

There was a patient there that I have never forgotten, even though this was almost fifty years ago.  She was a teenager, her family were from India.  She had not yet been completely diagnosed but had all the features of schizophrenia and was admitted after her family stopped her from climbing out of her upstairs bedroom window, as she was sure she could fly.  Her parents signed her out within 48 hours of admission.  Their fear was not that she was mentally ill, but that their friends would believe she had been admitted for an abortion, and then they would never be able to get her married.  That was a stigma worse than mental ill-health.

I don’t know when or where I first saw the movie ‘One Flew Over the Cuckoo’s Nest’, but like most people, I was strongly impacted.  It told a tale both of mental health, and the US approach to mental health care at the time.  Who can forget Nurse Ratchett? She certainly had none of the compassion and caring that you would like to see in a nurse.  Instead, she assumed a position of dictatorial cruelty, treating the patients as less than human, calling them with a bell like Pavlov’s dogs: ‘Medication time’.  Jack Nicholson’s performance was great (of course he played a crazy person perfectly, with those eyes, what else could he be?) but even more memorable was the tall, silent, Native American, Chief Bromden.  But the movie reflected a time in US healthcare when institutionalization was the solution to mental health illness. 

This week there have been several occasions for me to ponder on the subject of mental health.  A book has been published about the intersection of mental health and race, and describes a time when African American people who were deemed to be mentally ill (and apparently  some of the diagnoses were made on the flimsiest of excuses, such as startling the horse of a white person) during segregation.  One man was admitted for speaking with an English accent (he was born in England, but apparently black people who speak with an English accent are mad!). It was decided by the powers that be, that a facility had to be built for these patients, and the patients should be used as free labor to clear the land and construct the institution (Crownsville, in Maryland). 

This is startling enough, but the tales of their horrendous treatment once the building is finished, the harsh and deadly conditions and outrageous treatment by the staff, are truly shocking.  Not only are the conditions terrible (at one point one third of the patients died), but the patients are used as free labor, working in the fields. 

The institution was closed in 2004, and thanks to the outcry and activism of a caring community (and partly to the research by the author), the stories are being told, and plans are in place to turn the site into a park and educational center.  But this tale exposes one of the most tragic aspects of mental health care, that most of us do not speak about our mental health, we hide our problems away, we don’t talk about family members who may be struggling with these issues.  My mother once told me that she was always looking for signs that her children suffered from what she called ‘melancholia’ (the old name for depression), for my father’s uncle, and her own sister did. 

This week Elmo (yes, the character from Sesame Street) sparked an outpouring of public grief on a social media platform by merely asking a question: ‘How are you doing?’.  Perhaps it was because the first person who responded answered about their state of mind, their emotional and mental well-being (or lack thereof) rather than their physical health, that the country continued in that vein.  Not being a follower of that social media platform, I only heard about it on the news.  But it shows how easy it is to get the conversation going.

We are living at a time when the whole world has experienced living through a pandemic, with all of the physical, emotional and mental scars it created.  In the US (and elsewhere), the world seems to be more divided than ever, so we can see and feel the cruelty casually handed out to anyone deemed as ‘other’.  Despite the declaration by organizations to ‘eliminate disparity’ in healthcare outcomes, we are doing a terrible job.  Another book recently published, and also written by an African American woman, details the legacy of racial discrimination in the healthcare field.  She herself (a physician) was sent home three times from the emergency room with misdiagnosed appendicitis, and almost died once the appendix ruptured. 

The overwhelming message obtained from all of these stories is the importance of listening.  If we want to live in healthy communities, we need to reach out to our neighbor and ask them how they are doing.  It may be a friend you rarely call, but when you do, you find out that they need help.  It may be listening to someone who just needs to talk.  It may be (for those at the bedside) actually paying attention to what a patient is saying, and believing them.  It may be sharing your own struggle, and encouraging others to reach out when they are in need.  We are all in charge of the health of our community, and each other.

On this cool Florida Friday morning, I hope you know you can reach out if you need something, and I hope you are there when I need someone to talk to.  It is time for us to shift the conversation from divisive and cruel to kind and inclusive, a return to recognizing our common humanity, for the good of all.

Have a wonderful weekend, Family!

One Love!

Namaste.