Insights and Innovations in Community Mental Health The Erich Lindemann Memorial Lectures organized and edited by The Erich Lindemann Memorial Lecture Committee hosted by William James College Table of Contents Foreward ............................................................................................................................. 4 Enhancing the Skills of Mental Health Practioners: Treating Mind and Body and Spirit .. 5 Introduction by David G. Satin, MD .............................................................................. 6 Dedication to Louisa Pinkham Howe, PhD by David G. Satin, MD ............................... 7 Stanley J. Berman, PhD ................................................................................................. 9 Introduction by David G. Satin, MD ....................................................................... 9 Stanley J. Berman, PhD—Body ............................................................................... 9 Clinical Health Psychology: An Introduction ..................................................... 9 The Lens of the Clinical Health Psychologist: Eight Key Variables................... 11 Learning Theory and Cognitive Behavioral Models .......................................... 12 Learned Helplessness and Self-Efficacy ............................................................ 13 Stress and Coping .............................................................................................. 13 Ethnocultural Variables ..................................................................................... 14 Meaning Making and Existential Issues ............................................................ 14 The Transtheoretical Model............................................................................... 14 The Biopsychosocial Hierarchy ......................................................................... 15 Health Psychology Applied ................................................................................ 16 Martha Stark, MD ......................................................................................................... 18 Introduction by David G. Satin, MD ...................................................................... 18 Martha Stark, MD—Mind ...................................................................................... 18 Anticipated Course of Treatment ..................................................................... 24 John T. Chirban, ThD, PhD .......................................................................................... 27 Introduction by David G. Satin, MD ...................................................................... 27 John T. Chirban, ThD, PhD—Spirit ....................................................................... 27 Insights and Innovations in Community Mental Health | Lecture 22 | May 14, 1999 2 I. What Is the Spirit? ......................................................................................... 28 II. What Is the Impact of the Spirit on Our Theoretical Stance?...................... 30 III. What Are Positive Resources of the Spirit for Treatment? ........................ 32 IV. How Do We Approach Religion and Spiritual Concerns in Treatment? .... 33 Applications in the Case of Odessa ................................................................... 34 Discussion .................................................................................................................... 38 Insights and Innovations in Community Mental Health | Lecture 22 | May 14, 1999 3 Foreward The Erich Lindemann Memorial Lecture is a forum in which to address issues of community mental health, public health, and social policy. It is also a place to give a hearing to those working in these fields, and to encourage students and workers to pursue this perspective, even in times that do not emphasize the social and humane perspective. It’s important that social and community psychiatry continue to be presented and encouraged to an audience increasingly unfamiliar with its origins and with Dr. Lindemann as a person. The lecturers and discussants have presented a wide range of clinical, policy, and historical topics that continue to have much to teach. Here we make available lectures that were presented since 1988. They are still live issues that have not been solved or become less important. This teaches us the historical lesson that societal needs and problems are an existential part of the ongoing life of people, communities, and society. We adapt ways of coping with them that are more effective and more appropriate to changed circumstances—values, technology, and populations. The inisghts and suggested approaches are still appropriate and inspiring. Another value of the Lectures is the process of addressing problems that they exemplify: A group agrees on the importance of an issue, seeks out those with experience, enthusiasm, and creativity, and brings them together to share their approaches and open themselves to cross-fertilization. This results in new ideas, approaches, and collaborations. It might be argued that this apparoach, characteristic of social psychiatry and community mental health, is more important for societal benefit than are specific new techniques. We hope that readers will become interested, excited, and broadly educated. For a listing of all the Erich Lindemann Memorial Lectures, please visit www.williamjames.edu/lindemann. Insights and Innovations in Community Mental Health | Lecture 22 | May 14, 1999 4 The Erich Lindemann Memorial Lecture Committee presents THE TWENTY-SECOND ANNUAL ERICH LINDEMANN MEMORIAL LECTURE Enhancing the Skills of Mental Health Practioners: Treating Mind and Body and Spirit We have been through an age of clinical specialization, which results in fragmentation of health and mental health care. This violates the essence of community mental health. As society rebels against dehumanization there is increasing interest in reintegrating people and community life. The speakers will offer their expert perspectives in a case conference format addressing trauma, with the goal of expanding and integrating competence in caring for mind, body, and spirit in clinical practice. We then are better able to meet the needs of whole people. Case Conference Participants Stanley J. Berman, PhD, Visiting Associate Professor, Department of Psychology, Wellesley College; Director, Institute for Clinical Health Psychology, Massachusetts School of Professional Psychology. John T. Chirban, PhD, ThD, Clinical Instructor in Psychology, Harvard Medical School; Professor of Psychology and Chairman Department of Human Development, Hellenic College/Holy Cross School of Theology; Adjunct Instructor in Psychology, Massachusetts School of Professional Psychology; Co-Director, Carlisle Counseling Associates; Director, Cambridge Counseling Associates. Martha Stark, MD, Faculty, Boston Psychoanalytic Institute; Faculty and Supervising Analyst, Massachusetts Institute for Psychoanalysis; Instructor in Psychiatry, Harvard Medical School; Author, Working with Resistance and A Primer on Working with Resistance (Jason Aronson, 1994), and Models of Therapeutic Action (Jason Aronson, in press). Moderator David G. Satin, MD, LFAPA, Assistant Clinical Professor of Psychiatry, Harvard Medical School; Chairman, Erich Lindemann Memorial Lecture Committee Friday, May 14, 1999, 2:30 – 5:00 pm Massachusetts School of Professional Psychology 221 Rivermoor Street, Boston, MA 02132 Insights and Innovations in Community Mental Health | Lecture 22 | May 14, 1999 5 Introduction by David G. Satin, MD There is abroad a lively interest in integrated views of life and health, and treatment approaches. Perhaps this is a healthy reaction to the disintegration of society and lives as a consequence of long-term trends in industrialization, population mobility, and family cohesion. The Lindemann Lectures have addressed current pressures toward the depersonalization and dehumanization of health care policies, economics, and practice. Today we have prepared an exercise in a multifaceted and integrated approach to mental health practice. The presenters are familiar with the broad perspective on clinical practice, and will try to demonstrate it for the consideration of and elaboration by those in the audience who give and/or receive health care. The integration of physical, psychological, and spiritual healing has a long history. To take only one example, in the first decades of this century the Reverends Elwood Worcester and Samuel McComb at Boston’s Emmanuel Episcopal Church reached out to work with internists like Richard Cabot and Joseph Pratt, and psychoanalysts like Isadore Coriat in the rehabilitation of those suffering from tuberculosis, alcoholism, and neuræsthenia, using medical, psychological, and spiritual means. They wrote the books Religion and Medicine: The Moral Control of Nervous Disorders [Worcester, E., McComb, S, Coriat, I. (New York: Moffatt, York, 1908)], and Body, Mind and Spirit [Worcester, E., McComb, S. (Boston: Marshall Jones, 1931)]. The “Emmanuel Movement” inspired professionals and laymen across the country, at the same time that it inflamed defenders of traditional professional boundaries. Eventually it was lost and forgotten. Is there a message in this about collaboration and change? This issue was near to Erich Lindemann’s heart. He himself was both a social psychologist and psychiatrist. He strongly advocated the inclusion of the social sciences in medical education