JFK & Mental Illness

Exactly fifty years ago John F. Kennedy was inaugurated President of the United States, and during the past week we have been reminded both of his inaugural address and also of the death of one of his last living close associates, Sargent Shriver. Let us also look back on Kennedy's commitment with persons who display mental illness and mental retardation. His message "To The Congress of the United States" (from "Message from The President of the United States relative to Mental Illness and Mental Retardation; February 5, 1963; reprinted in American Journal of Psychiatry, Feb. 1964) was the impetus for many of his fellow citizens to know more about, conduct research on, and treat these two conditions--fulfilling, at least from my view, mandates included in the Sermon of the Mount:

It is my intention to send shortly to the Congress a message pertaining to this Nation's most urgent needs in the area of health improvement. But two health problems--because they are of such critical size and tragic impact, and because of their susceptibility to public action is so much greater than the attention they have received--are deserving of a wholly new national approach and a separate message to the Congress. The twin problems are mental illness and mental retardation.

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Mental illness and mental retardation are among our most critical health problems. They occur more frequently, affect more people, require more prolonged treatment, cause more suffering by the families of the afflicted, waste more of our human resources, and constitute more financial drain both upon the public treasury and the personal finances of the individual families than any other single condition.

This situation has been tolerated far too long. It has troubled our national conscience--but only as a problem unpleasant to mention, easy to postpone, and despairing of solution. The Federal government, despite the nationwide impact of the problem, has largely left the solutions up to the States. The States have depended on custodial hospitals and homes. Many such hospitals and homes have been shamefully understaffed, overcrowded institutions from which death too often provided the only firm hope of release...

There are very significant variations in the impact of the incidence of mental retardation. Draft rejections for mental deficiency were 14 times as heavy in states with low incomes as in others. In some slum areas 10 to 30 percent of the school-age children are mentally retarded, while in the very same cities more prosperous neighborhoods have only 1 or 2 percent retarded...

We must act--to bestow the full benefits of our society on those who suffer from mental disabilities; to prevent the occurrence of mental illness and mental illness whenever and wherever possible; to provide for early diagnosis and continuos and comprehensive care, in the community, of those suffering from these disorders; to stimulate improvements in the level of care given the mentally disabled in our State and private institutions, and to re-orient those programs to a community-centered approach...to reinforce the will and capacity of our communities to meet these problems, in order that the communities, in turn, can reinforce the will and capacity of individuals and individual families...

These words have had a massive effect, from creating an awareness and charitable response among citizens in the entire nation, saving many lives that would have been lost, to building many effective programs while introducing the opportunity for waste and even fraud in others. From my view Head Start is one of the valuable and functioning legacies--the greatest cause of mental retardation is now not the slum areas Kennedy noted, but rather genetic causes, many identifiable in the womb. Early intervention programs for children have brought a normal or near-normal life and subsequent economic productivity to many who would have been a burden on society or their families. Research studies funded through the National Institute of Mental Health and Veteran's Administration have brought greater effectiveness in treatments for schizophrenia, depression, post-traumatic stress disorder, and other conditions. There are community mental health centers, funded by Medicaid, where quality psychological help is available for poor people. Perhaps one of the greatest positive effects has been in brightening the lives of the mentally retarded, many who have been allowed the opportunity to be proud citizens of their communities.

Despite all of these wonderful things occurring, Kennedy's words have not been a panancea, and as Christ would note, the poor in Spirit--those with mental retardation and mental illness--still reside with us. When the large psychiatric institutions were closed--some of these had over 5,000 residents--too large a number of patients were unable to adapt, and now we deal with the problem of too many homeless people on our streets. They are there, not by their own free will, but because of insurmountable emotional and psychiatric problems. I surmise--lacking research findings or statistics--even that some of the unstable and dangerous persons who live among us have slipped through the cracks, and may have found, in a system with larger institutions, places of care and asylum. And still another problem we deal with in the gigantic bureaucracy is Medicaid Fraud--a two edged sword which can allow public monies to be stolen while at the same time keep eligible persons away from the help they deserve.

Can we learn from Kennedy's "national mental health program and the national program to combat mental retardation" which he proposed and which found great support after he was assassinated? Kennedy's words have gone beyond being fond memories or inspiration--they are now part of history, and with this perspective perhaps their real consequences can be separated from their ideal hopes, and we can apply this knowledge and discussion to similar national issues which face us today.

William Van Ornum

 

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we vnornm
7 years 8 months ago
Thanks David! I remember how the enthusiasm form this address and from the Community mental Health Act and head Start continued into the late 1970s and early 1980s when I began my career. bill
we vnornm
7 years 8 months ago
Note to Everyone:

Thanks to Tim Reidy for his research in finding the great photo. You can see the people identified in the photo at:

http://www.arcmass.org/jfk/tabid/635/Default.aspx

Jesuit Father Robert Drinan, SJ was instrumental in helping to put Kennedy's ideas into action. bill
Kayna Pfeiffer
7 years 8 months ago
I think that early intervention and intervention in general is the best way to combat mental illness. As you said Bill, programs such as Head Start have been effective in helping these children. More programs like this need to be created given that almost every American is affected by mental illness either personally or through a friend or loved one. Currently I am interning at Mental Health of America. This agency provides amazing services to the mentally ill and helps ensure they are able to get the help they need to carry out a life as normal as possible. Case managers are amazing at working with these people and helping them reach their goals, whether it is a social, financial, or mental wellness goal. These programs are so successful and make so many people happy. I wish there was more state funding for these programs. I understand with the current economy this may not be feasible, but I hope in the near future this will be possible. 
Marie Rehbein
7 years 8 months ago
Things have taken a turn for the better, no doubt, but we likely will always have to make a conscious effort to concern ourselves as a nation with the needs of the mentally ill and mentally retarded.  In my opinion, money spent on these issues is money well spent.  We should not expect there to be a program that does not involve establishing a fraud monitoring component.
Janice Feng
7 years 8 months ago
Our country needs to continue following in Kennedy's words and make sure that people who display mental illness and mental retardation get the attention they need in order to live their lives. Although some may take advantage of benefits originally set up to help these people like Medicaid Fraud, the overall results are positive. Lately as our economy has been on the decline, our community and government have seem to lose sight of Kennedy's words. Services based on bettering the community are the first to experience a cut in government funding. Short term, this may seem to save our government money, but in the long run as Kennedy discussed if not helped will continue to affect other parts of the community and the people in it. We need to focus the resources we have on helping those in need, whether it be those mentally ill or those who need support, and our community on a whole will experience those benefits.
we vnornm
7 years 8 months ago
David,

Head Start and Early Intervention programs-no chemistry involved! Teaching, singing, interacting, tutoring.....great programs. bill
we vnornm
7 years 8 months ago
David,

I don't think anyone is suggesting that anyone be forced to receive services.

Janice, good thoughts. bill
Molly Roach
7 years 8 months ago
A legacy of the Kennedy' was the beginning of the de-stigmatizing of mental retardation and mental illness.  We're not there yet but a beginning has been made.
It seems reasonable to conclude that JFK's concern came from the experience of his sister Rosemary's struggle with mental retardation.  Eunice Kennedy Shriver's exemplary work in support of the mentally retarded can certainly be traced to this.
One of my brothers was diagnosed as mentally retarded in the mid 1950's.  In retrospect it seems clear that he had serious learning disabilities.  We have long since learned to identify such disabilities and provide effective treatment for them.
More distressing is the anxiety that can be fueled by the experience of being different.  Children can be very cruel unless they are raised and educated otherwise. It may be this anxiety and the isolation attending it that David Smith is referring to.
Marie Rehbein
7 years 8 months ago
David, I think one option is better than no options.  One good option is better than a number of poorer options.  It's an imperfect world.  Perhaps, you are only playing devil's advocate...
7 years 8 months ago
David Smith said, "If all we're doing is trying to force them to act 'normally' enough that they can live in an apartment and hold a job without breaking down, aren't we really just forcing them to fit a mold that may be inherently alien to who they are?  Mightn't we really be twisting them out of shape so that they don't bother the rest of us?"

Not sure if that was meant to be snark or not.  But this notion of "who we are," always troubles me, as if we are all born with an immutable self that we should never attempt to modify, mentally impaired or otherwise.  I hate getting up in the morning and going to work everyday; it's definitely not "who I am," but as a member of society we all have an obligation to not become burdens on others if we have the ability to do so, happiness be darned.  Surely (with exceptions for associated risks to causing danger to others) it's always better to make those who could be productive, become productive and hope that they find happiness in it.
Ramona Vosburg
7 years 8 months ago
I remember this statement firsthand by President Kennedy also.  It was not Chemistry that made it possible to discharge patients to the community in a wholesale, unplanned fashion.  It was more a question of dollars, at least in CA, in the late 60's and early 70's.  Presidential and government support meant that new modalites of treatment and community environments were explored, developed and sanctioned.  The field of Education considered providing more services - government-funded - in the classroom and providing early education and psychological opportunties for those requiring special education services.  Improved pharmacology allowed many people to remain in communities rather than institutions; but we have never grappled successfully with the problems of those who can only live healthy lives, off the streets, if they have a long-term ''institutional home'' of some degree - be it a small care home or group living setting.  With developmental and mental challenges in the President's own family, it became more acceptable for those who were hidden, both figuratively and literally, to come out into the light of day and to be seen in the fullness of their humanity.
Bill Collier
7 years 8 months ago
I fear that we may be entering a brave new world of "treatment" for at least some forms of mental retardation-e.g., the in utero genetic screening that has led to an increase in the aborting of embryos and fetuses with Down Syndrome. Not only are the lives of the innocent being abruptly ended, but we as a society lose something of our essential humanity and empathy by such destruction. Eunice Shriver transposed the love she had for her sister Rosemary to a lifelong commitment to the mentally and physically challenged. My extended family also has its Rosemary, and we are immensely the better for it.  
Casey McGowan
7 years 8 months ago
Since the 1960s, I think the country has made great advances in the educational system. While some areas certainly lag behind others, often for economic reasons, I do think that strides have been made in creating a more level playing field. Disadvantaged students now have more opportunities to succeed, cutting down on the issue of mental retardation and illness there. However, as has been mentioned, many adults with mental health problems are living on the street. Since we have been able to at least partially address the issues within the educational system, I think it is time we turn our attention to helping the homeless population. I am not advocating that we force them to do anything, but perhaps if there were more programs and options available to them, we could help reduce the incidences of mental illness among that population.
7 years 8 months ago
I read Bill's blog and the comments yesterday after returning home from a marathon lunch date with a friend and fellow retired social worker.  We both have children who are schizophrenic.  Her middle-aged daughter has lived on the streets for 4 yrs  and has lost custody of her children,  My friend is 78 and her husband is 85.  They continue in every which way they can think of, to get help for their daughter.  As they are Jewish they have looked into services provided by Jewish organizations (and there are many fine services and resources in the Jewish commulnity here) and have found nothing. I am Catholic and have found nothing in the Catholic community for my son, who is dually diagnosed with schizophrenia and autism. 

Going back to Bill's reference to the beatitude, the poor in spirit, which our children and many, many more mentally ill persons exemplify,  I have to ask why our church is not responding to their and their framilies needs.  In our diocese we seem to have a ministry for just about every need,,but none for the mentally ill.  Because our diocese was hit with an almost 100 million dollar sexual abuse settlement,  all ministries and education have suffered cuts.  The director of the social ministry told me that he thinks the church is in the middle ages regarding mental illness.  So,I've come to the conclusion that help must come from other sources and it seems to me the issue is both one of social justice and of pro-llife.  How does one get the Catholics in these movements to get together and instead of continual arguing do something for "the poor in spirit"?

With deep cuts in Medicaid and SSI, we can't rely on the government for future needs.  The greatest fear for families of mentally ill and/or developmentally disabled children is what will happen when I can no longer care and provide for them?  My hope is with the young people, like those who commented on this blog and who have commitments to living out the Gospel  in service to others.  I also hope that people in the pro-life movement step up to the plate and follow the pro-life philosophy to its logical conclusion,helping all mothers who give birth regardless of the condition of the child.........and throughout the life span of those children who are mentally disabled.

Regarding medication (chemicals).  They can be a gift from God when prescribed and managed by a competent psychiatrist.  My son was free from psychosis for 16 yrs on one medication.   He is now on another one as the first one stopped being effective. 

It is one thing to philosophize about autonomy, choice, options,etc.  It is another to witness a person in the throes of a psychotic episode, hallucinating, delusional, unable to care for their basic needs.  I do favor laws that mandate out-patient treatment and am wondering about mandated in-hospitalization.  What are "civil rights" good for if you are living in filth, cold and danger on the streets and your loved ones are helpless to do anything about it?

As a young, idealistic social worker at Catholic Charities, I was inspired by the words of JFK, never dreaming that the subjects he spoke about, mental disabilities, would become the dominant realities of my life.
7 years 7 months ago
I'm a big fan of the early intervention programs. In high school, I worked at a camp for children and adults with disabilities and it was one of the most rewarding experiences I've ever had.  Now in college, I'm exploring the concept of early intervention and other fields related to that as a career. I find it so interesting and so great to be able to diagnose and understand the reasons a child may be acting differently or have trouble progressing in comparison with another, and to be able to give them the help that they need and the possibility of living like everyone else does.  It's so important that we keep in mind that these kids are people too, that they have feelings, that they want to have fun, that they want to enjoy life just like everyone else does, and with programs like that we can give them that chance.

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