In 1940, when the Hogg Foundation for Mental Health was born, the set of questions and challenges facing the foundation and its allies were catastrophic in scale. The world was going to war. The nation was only just beginning to recover from an economic depression that cast into doubt the fundamental viability of liberal democracy. Many people wondered whether western civilization itself was on the verge of extinction.
The hope of the burgeoning mental health profession was that it was precisely the tools and concepts of mental health that would enable us to find our way out of the darkness. A superior understanding of human nature would lead to better therapies, better parenting, more precise and effective interventions, and ultimately more humane and less war-prone societies.
More than seventy-five years later, we have two kinds of answers to the questions that were posed in 1940.
One is a very fortunate answer. Western civilization persists. We were not doomed to a new Dark Ages.
The other answer comes in the form of the steady, despair-inducing drumbeat of names and places that blare from the news channels: Sandra Bland. Dylan Roof. Sandy Hook Elementary School. Fort Hood. Charleston. Michael Brown. Freddie Gray. Tamir Rice. Germanwings. Umpqua. Colorado Springs. San Bernadino.
It seems as though every month another tragic incident or crime emerges to suggest that the customary behavioral health frames that we bring to our work may not be sufficient to address what's going on in our country and our culture.
This past November, to celebrate and reflect upon our 75th anniversary, the Hogg Foundation addressed this issue directly, hosting a conversation with our colleagues and allies on the question: "How Do We Bring Wellness to an Unjust World?"
Not so shockingly, we didn't converge on any silver bullet solutions to the massive social problems that so many of us, across the political and disciplinary spectrum, are struggling with right now. Our problems with violence, racism, and inequality (among other issues) are too complex and entrenched to allow for that. If there were easy answers, we would have identified and implemented them by now.
What was surprising, however, was what seemed to me a shared recognition among the clinicians, advocates, consumers, academics, and community leaders in the room that in some fundamental way our community hasn't even been asking the right questions.
It was also surprising to me that so many of us, given a few hours and the encouragement to reflect, didn't turn to the language of our work lives, of best practices and cutting edge theory, but instead reached for the language of our hearts and souls.
We asked questions like, "Where is our sense of shame?" We lamented that we'd lost a set of shared values. We spoke words like truth, anger, justice, and love.
What I take from that isn't that we should dispense with the more clinical and theoretical concepts we deploy in our work. Love may make the world go round, but it's not always the most useful prescription for treatment, or for systemic mental health care reform.
In order to help us bring the higher commitments down to earth, we need theoretical structures and concepts like health disparities, economic inequality, cultural and linguistic competency, minority health, integrated care, collaborative care, trauma-informed care, the biopsychosocial model, recovery, etc. We need best practices and evidence-based treatment.
The problem comes, as I believe it has, when we allow ourselves to believe that understanding and knowledge on their own are sufficient to solve the problems that ail us.
This was the faith of many of the mid-century leaders in the field of mental health, when the modern American mental health system was taking shape. And it often was a faith, held with evangelical fervor.
The men and women who traveled the byways of Texas in the 1940s and 50s on behalf of the Hogg Foundation, spreading the gospel of mental health, even came to refer themselves as "circuit riders," after the early American clergy who spent much of their lives on horseback, ministering to far flung settlements.
That mid-century faith was in the power of reason and knowledge. If only we can identify the best practice. If only we can, through diligent research and experimentation, arrive at the most efficient delivery model. If only we can quantify and characterize the damage done by prejudice, poverty, neglect. If only the ignorance can be cured, the mental health of our people will follow.
It was a noble and ambitious faith. And the work that has been done in its name has been extraordinary. We are its fortunate heirs.
We're also, I've come to believe, its unwitting victims. Because although their path has produced enormous good, in many ways it hasn't lived up to its promise. Knowledge, it turns out, isn't nearly enough. And this is most apparent precisely in the space between the vastness of our accumulated knowledge and the unwellness in our culture.
Without an old-fashioned sense of shame, at the suffering we allow to endure through neglect and selfishness, we don't have the motive to act. Without a shared sense of values, about who we are and what we care about, we won't know where and how to act even if we can mobilize a sense of moral urgency.
I don't know any more than anyone else how to generate that shared sense of purpose and values. It's the work of broad social movements, inspired by true moral and spiritual geniuses, and it comes unexpected. Philanthropic foundations like the one I lead are rarely at the vanguard of such social movements, and I'm not sure it's appropriate for us to try to be.
What we can do, and I know this precisely from the example of those pioneers and evangelists of mental health who came before us, is think in the most fundamental ways about how the ideas and tools of mental health can help heal the world. We can give support to those who are doing the most creative and meaningful work. We can be skeptical of orthodoxies, including our own. We can speak from our hearts and souls. And we can have a true sense of mission.
My predecessors' faith in reason and knowledge was excessive. But I don't believe their sense of mission was.
The project of bringing wellness to an unjust world is one that's likely to go on, without satisfactory resolution, for as long as humanity persists. There are no answers, in the sense that we sometimes like to dream there are. But there are more and less courageous ways to bring us closer to a truly loving society. We should strive to be courageous.
[Illustration by Josh Gosfield]
A version of this post was originally published on the Health Affairs Blog, May 3, 2016. Copyright ©2015 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.