On the threshold of the community


	Alan Bodnar, Ph.D. is the Co-Director of Psychology Training at Westborough State Hospital, Mass. and a consultant in the field of leadership development.

By Alan Bodnar, Ph.D.

From a person's day of admission to day of discharge from the hospital, the idea of the community is the guiding principle, driving force and ultimate goal of successful treatment. We want to know what went wrong in the community; we offer communities of support and healing; and we involve representatives of the community in discharge planning. Sometimes we seem to speak of the community as if there was one specific location where so-called normal people live out their lives in peace and harmony - a Platonic ideal of the essential elements of all good communities, the kind of all-inclusive, welcoming neighborhood worthy of Mr. Rogers himself.

Yet, in truth, we know that there is no one, single, ideal community. There are communities within communities and each of them is a collection of saints and sinners, enclaves of the healthy and fortunate and precincts of those who seem forever in distress. Communities of every kind are always challenged to welcome newcomers and the potential newcomer always has a choice to make about joining.

Being placed in a community is not the same as becoming part of a community. When people are admitted to our state hospital, they are placing themselves or, more likely, being placed in a very specific kind of community. Until a person has come to accept and understand the fact of his mental illness, he does not want to be here in the physical sense. Yet, confining a person to the hospital does not make him or her part of the hospital community any more than it guarantees his participation in the many smaller communities that operate as units, houses, therapy or recreational groups. He can simply say no.

There is another, more important "here" where the reluctant patient does not want to be. Unlike the physical plant of the hospital, it is not a geographical location but a condition that we call mental illness, defining the company of millions of men, women and children who, even in our enlightened age, are misunderstood and stigmatized by many elements in society. It is no wonder that many of our patients decline the invitation to join, even though this same group can provide treatment, support, reassurance and encouragement. You do not have to be a psychiatric patient to experience the ambivalence of becoming part of a community. How many of us with our noses pressed up against the candy store window recognize that the barrier separating us from our desires may be of our own making? Perhaps we think we are too flawed for polite society, imagining that the authentic members of the community possess a level of intelligence, style or goodness to which we can never rise.

Or perhaps we are deterred by the perception that we are better than the community that stands ready to welcome us. We hear this story often in the hospital when new patients with fresh memories of better times recoil at the prospect of a group shopping trip in the hospital van. A similar dynamic keeps problem drinkers away from AA meetings, convinced as they are that they are not alcoholics. Maybe what we really fear is a loss of our individuality, the failure of the community to acknowledge our differences in its eagerness to affirm what all of its members share.

The hardest community for our patients to embrace is the society of their peers with mental illness. To willingly become part of this group is to risk being separated forever from the normal world but, paradoxically, joining the mentally ill can bring a person closer to the community of loved ones from whom he has been alienated. This insight was the gift that a young man in one of our groups left us with when he was discharged from the hospital after a comparatively short stay of a few months. Over a handful of group sessions, we saw him move from an angry, suspicious, cynical stance toward mental health professionals to an honest recognition that his former beliefs in conspiracies against him were delusions that now seemed preposterous. We were privy to only a small segment of a journey of acceptance that he said took him eight years to accomplish. He was happy to be going home and happy to be sharing good times again with his family, who were no longer trying to convince him to take his medication because he was mentally ill. He valued his medication and the clarity of thinking that allowed him to join his loved ones in laughing at the extremes of thought and behavior to which his illness had once led him.

Like this young man, we all stand at the thresholds of rooms whose occupants invite us to join their company. When we are ill in mind or body, we know what it is like to enter the society of fellow sufferers but, even in the best of times, a wide spectrum of communities beckons. Members of neighborhoods, professional societies, communities of worship and interest groups of all kinds invite us to join our experiences with theirs. The young man in our group challenges us to ask what rooms we may be reluctant to enter and at what cost are we hesitating on the threshold.

On the threshold of the community (November 2007 Issue)

By Alan Bodnar, Ph.D.

On the threshold of the community
(November 2007 Issue)