Fourth World People's University: Mental Health

December 1, 2018

Virginie is showing the guests the self care wheels; from l to r: Virginie, Heather, Laura, and Gordon; in foreground is meditation table used for the opening mindfulness time.

For our Fourth World People’s University session on mental health, we started and ended the meeting with a mindfulness activity to learn some techniques and also to create a calm, supportive atmosphere for engaging with the topic of mental health. We started in a large circle where about 25 people, including our guests, introduced themselves. The following report captures some highlights from the dialogue, which involved deeply personal comments from our participants and guests.

Our guests

Gordon Whitaker, a psychotherapist, graduated from Hunter College. He is an MSW and certified for alcoholism and addiction counseling. A former professor at Fordham University, he coached girls’ softball and men’s basketball. He is currently employed at the Karen Horney clinic as a therapist.

Heather Teeling, from The Door, is originally from Indiana. She came to New York City for her Master’s in Social Work and worked in settlement houses in the Bronx. After a taste of corporate life, she decided, “I’m going to go back to social work. I feel a calling to work with people.” She currently works with young people at The Door, an organization for teens, including runaway teens. Open to anyone between the ages of 14 and 24, it runs youth centers, offers reproductive health support, and is available for young people to discuss topics they might not want to talk about with their parents.

Laura Shapiro, a dancer and a choreographer, is the founder of the Quick Silver Dance (laura shapiro / quicksilverdance@wordpress.com). She presents new works incorporating current social issues in her art. She also provides movement wellness through Chi Gung, offers pre- and post-natal exercise training, and advocates for human rights and social justice though the arts.

Background on how we chose the theme - mental health

Virginie (Moderator): When we met at the end of September to choose the themes of the year, people wanted to work on mental health because mental health issues are a reality for many, if not all, of us, and because we wanted to learn from and educate people who suffer from mental illness and people who don’t.

Each of us has very different perspectives, backgrounds, experiences, and knowledge, and we need to put that together. We are all impacted by a mental health issue — either personally ourselves, or through somebody in our family or among our friends. Our prep team knows that this is a very sensitive subject, but we are also confident that the discussion we will have today will be full of trust, respect, and love.

Mental health issues can appear in each of our lives; but what many of you also say is that poverty is trauma. Poverty is trauma because every day you are in the uncertainty of whether you can feed your children tomorrow, find a job, or pay a bill. And sometimes it is like that day after day. This creates trauma.

I would like to read a few sentences from the Multidimensional Aspects of Poverty Research intermediate draft report. One of the nine aspects of poverty is a “Lack of adequate health and well-being.”

Poor health conditions related to the multiple dimensions of poverty that start in childhood are carried into adulthood and persist through a lifetime. For many, it is a shorter lifespan than for those living in more humane conditions, even if economic conditions change for the better. […] Government intervention, and subsequent lack of government accountability, has an enormous impact on the current mental health of people in poverty. The over surveillance and intrusion of government in the lives of poor people and the lack of trust in government by communities of color results in underreporting of mental health distress, and as a result, undermines successful interventions.

In this report, the link between mental health and poverty is very clear. How can different responses and strategies reinforce one another rather than go one against the other? There are a lot of angles to tackle that question that we will look at today. We took two workshops to prepare for our guests.

Presentations from first workshop: self-care wheels (prepared on November 2)

We wanted to start this conversation by recognizing that we make efforts every day to stay mentally balanced and to stay strong, even if life is very hard on us (Participants composed their own self-care wheels and in small groups integrated them into larger wheels which were presented to our guests).

Presentation from second workshop: Four Ls - living, laughing, loving, learning (prepared on November 16)

During that meeting we addressed how poverty intersects with mental health. For that, we got inspired by the Thrive NYC exercise called the 4 Ls: living laughing, loving, and learning.

Participant 1:From my experience in foster care, here’s how the 4 Ls were affected:

Living: it was very stressful, many different houses, going place to place, sometimes having no food or clothing.
Laughing: Never happy, isolated, depressed, and very angry.
Loving: no friends, no trust, no family reaching out, very alone.
Learning: different schools; growing up too fast.

If I had had help at that moment, what would have been different?

I found a teacher, the right teacher who helped me out at that time. She taught me self-worth; she taught me how to be a strong person for myself.
Therapy: I was a teenager at that point; you are going through puberty, and you’re dealing with a whole bunch of issues — girlfriend, boyfriends, trying to get through school. And I didn’t have anyone to talk to at that moment, so therapy would have helped. I found help with the behavior specialist, and the social worker, at a later point in life, when I was about to age out. It did help.

Participant 2:From my experience of homelessness, here’s how the 4 Ls were affected:

Living: I was in the street, no place to stay. I was not secure at all.
Laughing: Laughing for me was a force, I like to make people laugh.
Loving: that’s the first thing I lost. Because my family and friends were not helping me.
Learning: I need to learn by myself the way I will survive, by creating a strategy and learning about all the places I was going.

What helped?

I never lost hope, because I say I am innocent; I’m going to fight, to survive. I will maybe find a way to both survive and have a good time, somewhere, and get some communication and dialogue somewhere with some people. When you don’t communicate and you isolate yourself, it’s like you want to die.We have to communicate. I respect myself, even if people will not respect me at all. Empathy — I always do that; I understand people. Laughing for me was a force to fight against what I was going through. Also I was praying a lot. I have a strong faith, and that helped me a lot.

Guests’ Reactions: How does what you’ve just heard reflect your own practice and experience?

Gordon: Some of these things — loving and laughing — you don’t always recover that. These issues that we are talking about are issues that we address every day. And it is just like this, it is raw. I’m not surprised by anything that was said, and all of the wheels are great; they’re on point.All of this is mental health. Everything you see up here [Gordon pointed to the charts], the result, it is mental health.

Laura: I am not a mental health practitioner. I work with movement. I work with small children with disabilities; I work with adults with disabilities, seniors, pregnant women, so-called “normal people” who can be quite neurotic themselves and have their own issues. In addition to homelessness, all of the emotional issues can impact anybody in any kind of situation. I thought you were both very brave to get up and share as much as you did, and I really appreciate it. It was obvious that you have each come a long way from the trauma you have suffered. You are well on the path of recovery, so that is also very admirable.

Heather: A lot of this resonates. I work with a lot of young people at The Door. Many of our kids reside in foster care currently, or they used to, or they are residential. I have heard a lot of similar stories from the population I work with now, in addition to years past, when I was working with families and children who were involved with various systems. The thing what keeps jumping out to me is trauma. This constant feeling of feeling unsafe and feeling a lack of security — how that keeps us sort of operating at a level that is up here [in our heads] in terms of our nervous system. You’re always up here; you have to be so aware and so observant and always looking at what might happen. You said, "no trust." Of course, how could you trust? Who could you trust? Everyone has betrayed you; it would be stupid to trust. That is a survival mechanism, it’s a coping strategy.

You really highlighted the importance of maintaining communication with people, and a dialogue for your own sanity, essentially; how you were able to recognize that it was really important. I think it's amazing, because I am sure you had days when you didn’t want to speak to anyone, and maybe you didn’t. But, that said, it would also be really hard to do that. So there is also no shame in saying, “I just can’t. I can’t deal with it, I don’t want to deal with it. I can’t talk to him, I don’t want to tell my story."

Dialogue

1) How does poverty interact with mental health?

Poverty: cause or consequence of mental health issues?

Gordon: There are a lot of people who live in poverty who are not mentally ill. Can people become mentally ill because they are living in poverty? I think so. You wonder, how does that happen? Well, we become depressed. And some people become more depressed than others. Some people become anxious, much more than others. There are different levels to depression. There are four or five diagnoses of depression, four or five diagnoses of anxiety, and those are just the basic ones. We’re not talking about real mental illness, such as a person who has bipolar issues, borderline personality, or schizophrenia, for example. We’re not talking about that. We’re just talking about the general stuff. You’re looking at somebody and you say, “What’s wrong?” and they’re down, and they continue to be down, day in and day out. You're watching this person deteriorate. I see a lot of that, especially with homeless people.

I have a guy who has been homeless for five years. I was writing letters for him to all kinds of senators, congressmen, different people, asking, "Why is this guy still homeless?" You don’t get any answers. That creates depression. You're alone. You feel there’s no one there to help you. That’s real.

Participant: You don’t have to be in poverty to be broken, to have a mental illness. You could be rich as hell, or average, and have something be wrong.

Poverty is trauma

Participant: When we’re homeless, we start losing the mind and don’t want to communicate with anyone. Because what you’re looking for is space and silence. Space and silence. You need to focus on your problem, and what is going to be positive for you to get out of the street and get out of the trauma.

Participant: Last year, I lived in Lebanon, and I was exposed to the work people were doing with refugees coming from war. Everybody recognized that these families had gone through trauma, that the fact of having to lose their home, and having to flee, and to leave everything — it brings trauma. So every program that was in place had a worker competent to deal with the trauma and ways to support people who have been damaged. And I was thinking, I know many families who live in a country at war but (also) because they live in extreme poverty, they have lost their home, not once, but every two or three years; or every year they go through the trauma of losing everything and having the uncertainty of not knowing where they're going to live. I know many families, who were not at war, but who lived in neighborhoods where violence was a constant, and they never knew if their teenager was going to come back alive, and they have lost teenagers and young people to violence and to guns and drugs. And so, I knew what refugees were going through, and I knew that families living in extreme poverty have gone through that, only much, much worse.

Many of the wounds are not visible, and so you will treat someone as if poverty just hit yesterday, and you will ignore the rest. When we say that having access to mental health coverage is a privilege, I think it is also a question of not being able to look at people in their dignity and recognize what they have gone through. I don’t think we will treat people living in extreme poverty in the same way if we look at them the way workers look at refugees. They look at them as human beings who have gone through hell. If we were able to do that, I think we would be able to put in place services that are much more human and that would take into account the dignity of the person in front of us.

Gordon: All people who come to me have stress; all people have some kind of anxiety, some kind of depression — all of us — and we get it at different times. I get depressed from time to time; it happens. We also get anxious from time to time, but maybe not long enough to get a diagnosis. We all go through stuff, not just homelessness or foster care — it could be anything, anywhere that you find trauma. Trauma is something that happened to you, whether it happened twenty years ago or three years ago. I have some people who remember being three years old and being traumatized. So anywhere that you find trauma, there will be PTSD. People can suffer from PTSD because of incest, child abuse, all sorts of things. I have about 35 people that I see, all with different diagnoses, and when they come in I have to be ready.

Like I said, I am a motivator; I don’t want you stuck in that; I want you to get out of that. That’s my job — to help you get out of the funk that you are in.

Most people who come to the office come in with a suitcase full, we talk for an hour, and at the end of the hour, they pick that suitcase right up, and this goes on until [laughter] they finally leave it behind. That is what happens in therapy. It’s hard talking to people.

2. Why do people living in poverty have less access to mental health coverage?

Difficult process to get some help

Virginie: Because of lack of resources, nothing is done, and people lose their mind, as one of you said. Some of us said that they didn’t feel good, but there was nothing to be done, so the last resort was to go to the emergency room. I read an article that said that, especially for young people, there is nothing provided unless they get into the criminal system, then they can get help. Also, we often hear homeless people saying that they could get help only if they were recognized as having mental health issues. Being poor is not enough to be helped; you have to have some kind of illness or disability or mental health problem. So that really does not work.

Gordon: There are long lists of places available for people to go to. But there are so many forms that you have to fill out, and it is based on the attitudes of the people behind the desks. I’m being really nice, because there are some nasty people in the system that you have to deal with.

I just recently had a fight with somebody from one of the homeless shelters. They’re taking my guy and they’re putting him into a mental health homeless shelter. Now, he’s fighting this. He’s saying, “I don’t want to be there!” The problem is this: it really doesn’t matter, because they’re doing drugs, in these centers and you have people who are fighting for recovery [from alcohol or drugs]. That’s tough in and of itself. So for me, it’s a monster game, and no one is winning. People don’t win.

Participant: Mental health is very under the rug, so even when people ask for help, it’s a process. People tell you, "I don’t have an available appointment this day; you can call back." Even the hotlines do that. They have a protocol; we need less protocol. They make you answer this question, that question, and so on. And they tell you, "If you feel like you’re going to kill yourself, call 911." You get to the hospital, and you’re still waiting there. I have been in the psychiatric area of the hospital. Even the waiting period, when you want to get help, is a process. And then, when you feel better in the psychiatric ward, it’s even harder to get out. It’s like a constant circle. There is always a question mark, and then maybe a slight answer.

Participant: I have a question about the health system in the United States. My question is, are people overwhelmed? The people who want to take care of those homeless people who are having health issues, is it because they are overwhelmed? Is it because it’s a huge machine or is it because they don’t care? I heard you say that some people are nasty and they have their job, they just do it 9 to 5 and they go home. Or is it because it’s not working anymore, because it's such a big network of jobs intertwined that cannot communicate anymore?

Gordon: It’s all of that.

Mental health coverage is a privilege

Participant: I’m in grad school for social work, and the thing they teach us right now, is that for everything you look at, every structure, and every reading or interaction you have, you need to look at it through a lens of power, race, oppression, and privilege. Mental health coverage, and getting mental health services properly, is a privilege. It's race-based and it's class-based in a lot of ways. If you have hundreds of thousands of dollars in disposable income, you can go see a therapist once or twice a week. But from another class perspective, some people can make their own hours and take summer Fridays off and all these things; but someone who is in poverty doesn’t have that option necessarily to take off an hour in the middle of the day to go see their therapist. There is a power structure in place that doesn’t allow people to get the services they need.

The work of social workers is not valued

Heather: The problem is that those people who are nasty who work at the main social services office, they are not social workers. They don’t have the training. The salary for those jobs is not enough for a lot of people to live on in the city. I went to graduate school for social work. I’m going to be paying my student loans off until I’m dead. You end up hiring people who do not have the training or the knowledge of how to treat everyone who walks in the door. We are not valuing the dignity of the people in these situations.

We are not valuing the jobs of the people who do want to work with them. The fact is, social workers and teachers do not make a lot of money. As a society, we have to balance that. Hedge fund managers and CEOs of companies make hundreds of millions or billions of dollars every year; but teachers, the people who are educating our young people, who are really the future, are not making enough money. Some of us have to work multiple jobs. I think that’s a huge societal issue as well as these individual nasty people at these agencies. I was told there were a lot of youth centers that were getting government funding back in the 70s, but because of cuts in funding, The Door is one of very few left.

3. How to improve the system

Support groups and peer support

Participant: I know that everything has to have a process. But maybe — like in hospital they have people volunteering — maybe the psychiatric doctor is busy seeing someone, but in the waiting room while you’re filling out the paperwork, maybe a volunteer can come sit next to you and at least talk to you. Somebody is there helping you, and then you can get the official help.

Gordon: They don’t do that, because they want a qualified health professional to do that. Suppose you came into the emergency room and you had a psychiatric problem — let’s just say you felt like ending it all — and they ask just anybody to talk to you? That’s why they don’t do that. Those positions are paid positions for a reason. I couldn’t send you to just anybody to address your suicide issues. But, listen, there is a lot that is wrong with the system.

Participant: For example, if I’m having an episode and I go to the hospital and there’s nobody there except the seats and the glass window, and I am saying, "I’m Jessica Simmons," but that’s not my real name, and you take down whatever I say; there’s no one there to help. But when my daughter is sick and I’m there, there’s a volunteer in the emergency room, and she’s asking, "Do you want me to do this, to help you?” So, why is there a line? Where is the line between this diagnosis and that diagnosis?

Gordon: Because for some of the diagnoses, people are not going to recognize them; they’re not going to know what they’re looking at when they see it.

I agree with you to a point. Somebody could be there to help you with different things; they could ask, "How are you doing today?" Things like that; real basic stuff. Because sometimes just having a person there is important. I advise everybody in here, you need to talk to somebody. Find somebody to talk to, to say what you'll do, to say that it’s hard, or whatever. I heard the comment that getting mental health is a privilege. It is. It is tough out there. But you have to keep doing it.

At my clinic, where I work, everybody comes there with all different insurances. I don’t like the fact that we have insurance problems but we do. People sometimes asked not to come back, because Medicaid will cut them off or they have problems with other insurance companies. There are different issues. But I still say, it’s better to have somebody than nobody. That’s the difference between life and death, as far as I am concerned. And even in your situation — you want to self-isolate or you’re embarrassed or you don’t want to talk. The bottom line is: find somebody to talk to. No matter what. This is better than anything, just to have somebody to talk to.

Participant: Gordon mentioned the need for professional certified medical personnel, but it could be important to have someone hold your hand while you’re going through things. I wonder how any of you felt about peer support, and how that could have worked together with professional care, instead of it being an either/or kind of situation?

Laura: This is not directly related to a poverty issue, but when my father was dying of Alzheimer’s disease — this was back in the 80s when there was not that much knowledge about it and not that many services — just a few months before his death, I was referred to a support group. Their support groups were led by a psychologist or a social worker. I don’t know if they have training, these lay volunteers, or not, but it was very helpful to be in a group. I definitely think that could be helpful, even if it was led by a licensed mental health professional. More people could attend, the leaders could get paid, and there might be less cost than for one-on-one care.

Heather: If you are struggling with mental health issues, and maybe you are in the middle of an episode, you’re probably not really capable of filling out a hundred pages of paperwork. So maybe instead of just having somebody sitting with you and talking to you while you do the paperwork, they take it from you and ask you the questions, if you’re comfortable with that arrangement, to take just one little burden off you while you’re going through whatever it is you are experiencing. But I think it’s really hard, regarding some mental health issues, because there’s the question of liability. We live in this country where, unfortunately, everyone wants to sue everyone else.

Importance of building self-esteem

Gordon: I spend time building self-esteem. This gentleman comes to me and I have to deal with his self-esteem issues. He doesn’t like himself. He’s embarrassed. And then I have to send him out, to nowhere. And that’s a session: 45 minutes once a week. Sometimes I see people twice a week. All kinds of things have happened to them, all sorts of trauma that’s going on. My job is to make them to feel okay, going forward. And that is very difficult.

With diagnosis, I am extremely careful, because you write and people respond to it. For example, for a person who had to go through mandatory therapy, let’s say they worked in a bank and they happen to let their boss know they had to go to therapy. I’ve had people who were fired because they had a mental health diagnosis. The less that I write, the better, unless it is absolutely necessary for homicide, suicide, things like that. When I have somebody like that, I keep two sets of notes, because it follows you: everything is in the system. Nobody asked me how these things are found out. If you have been in the system once, you are in there. That is just how it is. I am very careful with diagnosis.

Heather: In terms of self-esteem: I work with a lot of kids who don’t have super-strong academics; they struggle with learning, cognitive, and developmental issues — things that get in their way. But if they can go to an art class a couple times a week that The Door offers (we have drama club as well), if you can build up your confidence in other areas, that can lead to anything. Even if you’re not good at math, you could be really good at playing the drums. For example, you feel really good playing the drums, everyone looks at you in a positive way, and that’s going to boost you up for the next couple of days until you go back. The Door is really good for that. I am not here to plug our programs, but you can see that people engaging in whatever makes them feel good — journaling, art, playing, going for walks (the parks are free), things like that — is important for people to do when they feel so downtrodden.

Art and movement as a way to take care of your mind

Laura: The movement practices that I do is how I negotiate being on this planet at this time. It’s very stressful even if you’re not homeless. I am not trying to put the seriousness of those issues down; I am just saying that there’s the energy that we all feel about what is going on, and it’s become very acute the past couple of years. When I am at work I feel like kind of a channel. I relate to everybody — what was said, whether it’s talking, writing, or making music. It's like the African saying: if you can walk you can sing, also dance. Everybody can find some kind of expression.

Heather: A number of my young people have been traumatized in the past or are experiencing trauma now. I am a full time yoga teacher in high school. I only have them for 45 minutes. Especially as westerners, we live up here in our heads. When we engage in physical practices, it changes the biochemistry in our brain, activating the parasympathetic nervous system, especially with the fight-or-flight reflex. Of course, if you are living in foster care and someone at school pushes you, of course the fight-or-flight is activated — you are going to punch somebody in the face, and then you are in even more trouble. Now they want to expel you; now where are you going to go; now your foster parent is mad because you got kicked out of school.

It looks like we are so often not connected with our physical self and like we are trying to remember that it’s all connected. So if you take care of this part [body] it can also have a really good impact on this part [head] too.

Virginie: We all recognize that going for a walk, doing yoga, or painting, for example, is very important for our balance, but I think that many of us don’t have the access to those kinds of activities or don’t allow ourselves time to do them. Going for a walk is free but it takes time, and many things are very expensive especially here in New York.

I would like to say something about Nelly who is a long-term ATD Fourth World activist in Switzerland. She wrote a book and she paints. She asked her social worker if she could go to an art class, and the social worker said, "We can pay for art therapy, but not for art class." Nelly’s point was she doesn’t need art therapy but rather an art class to paint and to be among other people.

Some counseling spontaneously happened during the meeting

A family took advantage of having a therapist in the room to talk about their situation.

The mother identified the issue: There are conflicts between me and my son (she gestured behind her) and the conflicts maybe need a referee between us. My child has a disability, he needs help.

Gordon gave some advice: That’s an anger management issue. You have to deal with your son. He has to be that way; the question is not about him, it’s about you. He’s not going to change. If I were counseling your son, I would ask him, "Can you not argue with your mother for a day?"

The son responds, "I am going to try. But really, I wish I could do drumming."

Guests' Takeaways

Heather: Thank you, everybody, for telling your stories. For me, going back to meditation practice or just to work on Monday, it’s really inspiring what I heard here tonight because — I am sure many of you have heard this —there is a lot of burnout in this field; because of the energy output, it's very tiring. And because of the larger system, you can wonder, "Are we making any progress? Is anyone actually helping anyone?" It’s been very inspiring. It reminds me why I do this kind of work and how important it is.

Laura: I am the kind of person who needs time to process experiences. Also my work is mostly non-verbal. I don’t have a lot of words to share, but I appreciate being here.

Gordon: It will be the same when I get there (back to work on Monday). This has been enriching — the knowledge that what I am doing is okay. I address a lot of the points that are covered up here [the 4-Ls charts]. I like to think positive and I would like for you to think positive. You have to hook up with the right person and you’ll be all right. But you have to be positive. Hopefully when I get back to work, on Monday, I keep that in mind.

Conclusion: Chi Gung

Laura: Introduces us to Chi Gung. Chi means life force energy, gung means life force energy practice. Using the six force healing sounds, we made sounds together with gestures related to a season of the year and a color. In Chinese medicine, they are organ meridians and also an emotion. We ended by some practicing energy movements.

To conclude the session, we enjoyed a hot pot luck supper together.

This report was prepared by the Fourth World People’s University prep team: Christelle, Emma, Marcia, Marie-Claire, Patrick, Samantha, Stacy, and Virginie.

Merging Knowledge, National, New YorkFebruary 12, 2019