Saturday, August 25, 2018

Mental Illness Navigators


We do have Mental Illness Navigators for our area. It has taken me over a year to find this out but they may not have been in operation when I first asked. What I did first was look on the internet for Mental Health navigators. If you do. search you will find them in various locations.

My introduction to navigators came when I needed an oncology navigation and found one at Genesis West in Davenport. She, a nurse, was most helpful in guiding my wife and I through the maze of doctors, appointments, treatments, tests, and side effects the last year of Bobbie's life. She helped us know what was happening to insure smooth transitions between appointments and outcomes.

Now I find the Mental Health Crisis Center located in the Davenport County Health office building provides navigator services. The main hurdle comes from not publicizing themselves with that language. I hope that changes. That brings up the whole topic of communication and collaboration.

At the last meeting of the Mental Health Board in August I gave a short background to what I have experienced this last year with two adult children now in long term mental illness treatment centers. One is at Bellevue Iowa and the other is at Dubuque. When I suggested the need for navigators one person said we have them and he gave the name of the person in charge of the crisis center. That was a note I wrote down as another location as I connect the dots for mental health care. Later this person and I had coffee to talk evermore about the current situation with professional caregivers.

A week laster I went to the first person I had contact with at the crisis center. She drew a diagram of how they services connect and who does what. I then knew that six months was the usual time for people to be in a long term facility before release to another agency in the system.

That is where I am at present. I will continue to wait out the six months until one of my family is moved to another dot in the system. Residential homes are in high demand. That would be the next step for both and in the meantime Social Security disability become a primary need. Both have started the process, been rejected, and continue to proceed.

Stay tuned, the story is open ended, and navigators are now tracking the journey.


Tuesday, August 21, 2018

A Huge Aha! From a Patient Visit.

Greetings One and All,
In 1964 I completed my third quarter of Clinical Pastoral Education at Bellevue Hospital, New York City. I now had enough quarters to become a certified Hospital Chaplain with the College of Chaplains. This became official in February of 1965, the year I became the first full time chaplain at St. Luke’s Hospital in Davenport, Iowa.
On my evening rounds making pastoral visits with patients before surgery I met an elderly man from Sugar Creek Township, Cedar County. That was where I grew up on a farm my first 8 ½ years. I lost my concentration in staying with his medical story when I learned he knew my Dad. My Dad as a young man played the fiddle for barn dances. He had died 18 years before so I was anxious to learn something about my father and my story source was now in front of me. I negotiated to return after surgery to tape record our conversation. He agreed. I offered my blessings and left anticipating my return to learn more about my father. 
My return visit with Mr Geibelstein turned out to be more than I anticipated. Being older he knew about the farms and families where I grew up. Farms were named after the families who lived there. There was the Hinkhouse place, Kaisers, Laucamp, Schroeder, etc., and then more than one Whitmer farm.  He again attested to knowing my father as a young man when he played the fiddle for barn dances. I said, “The violin I have may not be the exact one, but the strings on the bow are worn out.” He said, "Oh yes, we all wear out." He told of his friend visiting before surgery and saying, "You have to stay with the boat." I found this amusing since we read a portion of the Noah story in the chapel before my visit. I asked, "You have to stay with the boat? Cedar County doesn't have any large body of water. There isn't any ocean or sea out there." He said, "You have to stay with the boat in order to survive." Helped by his friend he moved the Noah story to himself. It is one thing to move "worn out" but now we have "stay with the Boat to survive?" I decided to drop my agenda and go with what was happening as he moved my words and others to explain his situation. He confided that he didn't think he would survive the surgery. There's a real flood.
He said my presence before surgery had been a comfort. And the words of his friend, “stay with the boat,” had stayed with him. Now he was alive when he didn't think he was going to be. What does he do? The recording session turned into a pastoral visit. Instead of the stories of my father I had a demonstration of how metaphors work in story listening and pastoral care for health care. The communication process became the greater gift. My father was innovative having patented an automatic calf feeder for young calves whose mother refused to feed them. Now innovation came in seeing metaphors move meaning in a story.  A new insight in how language functions had been recorded. Renewed life was generated in both of us.
Connecting with Philosophy in a New Key 
The recorded visit opened the door for understanding story and language in a more profound way. Aha! Even more amazing, I had this vague feeling that I had connected with this insight in my past. I went to a book on my shelf, Philosophy in a New Key by Susan Langer. She had a chapter on language with a page I had marked and sentences underlined 23 years before. 
Her chapter on “Language” was read my senior year at Hamline University, St. Paul, MN, where I was a philosophy major, graduating cum laud in 1952. My last year allowed for an independent study with Alfred North Whitehead as my major focus. Susan Langer was a student of Whitehead when he taught at Harvard. Whitehead began as a mathematician in England before coming to philosophy through the development of a symbolic logic. Langer picks up on the symbolic, moving the symbolic to all forms of human communication including language. The philosophical issue involved is known as “epistemology” where the question of how we know becomes central. For Langer our knowing is built into us by nature, we are symbolic beings. As the Book of Genesis says we were created to make images being created in the Image of God.
I had even turned the corner of one page as a marker in her book and significant sentences about metaphor were underlined. The seed germinated slowly while saving remembered stories to illustrate at the same time.  A future harvest was about to be reaped in the way words and expressions move to a new context for meaning in that context.
She gives examples in her book. 
Rereading pages 112-116 provides a refreshing reminder of what I was to discover in everyday conversations in a hospital setting. The fire of a stressful situation makes poets of us all. I am told the source for that idea is Shakespeare, another endorsement for metaphor, moving words from one place to another for meaning.
What caught my eye in 1952 for my first reading of Langer was her interest in meaning. “Langer's philosophy explored the human mind's continuous process of meaning-making through the power of “seeing” one thing in terms of another.” (Wippecyclopiedia).
I started college to become a chemical engineer. Out of money I spent fifteen months in an implement factory as a steel checker rubbing elbows with a lot of unhappy workers. I began asking questions chemistry was not equipped to answer. What is the meaning of this unhappiness? What are the deeper questions in life? I went back to college to major in philosophy. Susan Langer’s chapter on Language connected with my questions about meaning. “Meaning-making” had caused me to change my college major.    
What came from the rereading in 1975 after my visit with Mr. Geibelstein was how metaphor functions in communicating meaning. I had missed the full importance the first time even though I underlined the right sentences.
What I am about today and why I write is another Aha! This is about all of us, everyday, in whatever context we find ourselves. We relate metaphorically as we tell our stories, moving whatever word provides meaning, disguises, hides, or keeps us oblivious to what we have actually said at a deeper level.
Marlin Whitmer

Monday, August 20, 2018

Aha's! Open the Door: part 1

Greetings One and All,
I am starting a thread with the word Aha! My journey has been a continuing series of Aha! Even in the midst of pain, suffering, confussion, stress, being overwhelmed, there has been the Aha's! Gifts! Insights! New understandings! A new birth! Even a paradigm shift!

Death and Resurrection? Good Friday/Easter?
I begin with two stories from Bellevue Hospital, New York City. 
After my first Clinical Pastoral Education experience in the summer of 1953 I went back to serve for the vacationing night chaplain during the summers of 1960 and 1961. I was testing myself to see if chaplaincy could be my future vocation. My experience in several congregations after being ordained priest in the Episcopal Church in 1955 did not seem like like I was in the right place even though I seemed to be doing acceptable work. 
My goal from before, during, and after Seminary was, this seems rather audacious now, to develop the ministry of the whole Church (parish). My mentor and I had many conversations on this topic. I wrote a paper my senior year in Seminary on the subject. Now in the reality of parish life I wasn't making much progress. The ordained as the Minister was deeply ingrained and moving to the concept of all have a ministry, laity and ordained together, was resisted back in 1955 to 1965. I was paid and ordained to be "The Minister." Some changes have taken place since. We still have more to accomplish.
A necessary foundation for the Aha! was Story listening, an outcome from the ‘53 experience with Fred Kuether as Chaplain Supervisor at Bellevue Hospital. There a few of my pastoral visits began to net an Aha! Experience. A surprising outcome for both speaker and listener caught my attention, especially the listener in my case.
I will share two stories, one from my visits as night chaplain and another as a Clinical Pastoral Education student. 
Before surgery at Bellevue, a hospital requirement, all patients were seen by either a Roman Catholic Priest, a Rabbi, or a Protestant Chaplain. After the visit you signed your name on the temperature page in the chart. Patients with no preference or from another tradition were seen by all three clergy. If this was not signed you could be called to the operating room to see the patient before going to surgery. They followed the rule. I am sure it is different now.
I visited a young black lady from the south. From the beginning of our conversation I could tell she was extremely nervous. I Proceeded slowly as I learned she was to have surgery on her heavy bandaged infected elbow. The operating schedule informed me ahead of time but I wanted to hear from her what was about to happen. Surprise, as she told her story she suddenly bent over putting her hand to her face. When she raised up there was a glass eye in the palm of her hand and an opening in one eye. Aha! Her last experience in surgery was the loss of an eye. Was she about to lose an arm? As our conversation continued she asked me to read Psalm 31. I carried a small Book of Psalms with me since such requests was not out of the ordinary from some patients. Reading the long Psalm was like reading her autobiography with suffering. Like many laments the turn around came at the end. I repeated it twice, the second time as a prayer. The next day I returned to see what happened. Some distance from her bed I knew from the big smile on her face. She still had both arms.
Bellevue was a training hospital for four medical schools in the 50's and 60’s. Researchers and Specialists were present and available for conversation in the Dinning Room. This story comes from my chaplaincy intern days and involves a patient from Thailand who was scheduled for both a goider and heart surgery. Six times the surgery was canceled because of risk with her rapid heart rate. That made for a number of visits. We were getting acquainted in spite of her broken English and he was meeting with all three chaplains from their traditions since she was a Buddhist.  Another day she was scheduled and I was visiting again. This time the surgery was performed successfully. The day after I made a follow up call and out of her mouth came these excited words in broken English, “I feel like new born!” Aha! I have never forgotten her metaphor for new life. Since her sister was married to a naval officer at the Thai Embassy in Washington DC, I made a visit to her sister's home while she continued to convalesce.  My seminary was in Alexandria across the Potomac. 
In both of these stories I was on my way to discoveries that would net greater Aha's! The seeds had been sown but germination takes time. And different seeds germinate at a different rate. How about 25 and 26 years. Slow learner.

Listening as Self Emptying

Greetings One and All,

There is a biblical principle for becoming more skilled as a story listener. There are different ways of talking about this principle but what is most surprising is the agreement from more than one source. I am going to show how Scripture (Philippians 2), a medical doctor, and a pastoral care researcher all emphasize the same principle. 

My way of talking about this principle is to drop our own agendas while listening to the other person's story. We are to have nothing up our sleeve. We are to be as non-manipulative as possible while attending to what the other person is saying. 

On occasion I have called listening "Christmas," a present Incarnation,  where you make room in the inn of your consciousness for the new that is unfolding in the story. Rachel Stanworth uses the term "spacious listener" where we give the other person space to tell their story.

Getting back to Philippians 2 and the line, "Have this mind in you which was in Christ Jesus." (Phil. 2:5) There are a few lines before it.  "2 complete my joy by being of the same mind, having the same love, being in full accord and of one mind.   3 Do nothing from selfishness or conceit, but in humility count others better than yourselves.   4 Let each of you look not only to his own interests, but also to the interests of others.   5 Have this mind among yourselves, which is yours in Christ Jesus,"  

The word Mind is used three times. The Greek word for mind here is a very specific word, forms of phronesis, meaning a down to earth and practical mind. You might think the Greek word sophis would be used here for Christ. Sophis refers more to wisdom or ultimate realities. The word says a lot about the mind of Jesus from a practical standpoint. There are other passages to support this down to earth approach but lets start here. Being down to earth and practical may not be the easiest thing to do at times. I find it down right difficult. A real disciplined perspective may be needed as we proceed. We are talking about our preparation to listen. Paul continues in talking about Jesus preparation in being along side us.

"6 who, though he was in the form of God, did not count equality with God a thing to be grasped,   7 but emptied himself, taking the form of a servant, being born in the likeness of men."   

Emptied himself becomes the crux of the message. Kenosis in Greek. The word will be moved by folks who talk about listening to convey our own preparation.

Dr. Rita Charon in her book Narrative Medicine has this to say about listening.

"Attention connotes the emptying of self so as to become an instrument for receiving the meaning of another." (Charon, p. 132)

Rachel Stanworth did a research project at St. Christophers Hospital in London. She interviewed 25 people who were dying. She heard their stories, their concerns, and especially the words they used to convey what has happening to them. She transcribed all the interviews and came up with 9 metaphors for expressing the commonality in their stories. What may come as a surprise is the early section of her book is given to her own preparation for the task of listening. She too writes about self emptying in this way.

"Slowly, I began to learn that to really hear another is akin to an active divestment of self." (Stanworth, p. 39)

The footnotes of both books indicate neither has read the other. Without any collaboration they both join with St. Paul, the down to earth and practical mind to hear the significant story of another begins with the discipline of self emptying. 

By the way, St. Paul advocates this kind of mind for every day folk like you and I. He says this mind is ours in Christ. Don't let professionals become an excuse because they advocate the same.   

As Christ is the Incarnate one, the word was made flesh who dwelt among us, our listening at its best participates in that same Incarnation mode as the word of another takes on reality in our understanding.

Marlin Whitmer

Saturday, August 18, 2018

A Letter to the Editor, August 18, 2018

This letter appeared in the Quad-City Times on the Opinion page. I also have the opportunity to write a longer article for the RiverCity Reader.

Mental Health Care is Inadequate

I have been over my head in family mental health issues this past year. I gained a frontline view.

Iowa legislature moved forward with the Eastern Iowa Region Crisis Center. The people at the center were helpful. But ultimately, Iowa continues to go backwards:

Reduced the budgets of the judicial system and the Department of Corrections two years in a row when 40% of the inmates in the Scott County Jail have mental health problems.  

Removed the court from the hearing decision after a 72 hour committal. Because of the new rule on July 1, the hearing never happened, no judge was present, and I wasn’t even present. They sent the patient home in a taxi. The result: We had to go through the committal process all over again.

State officials refused to address the shortage of long term beds for the mentally ill. According to the NAMI of Iowa (National Association of Mental Illness) “ … in 2016, Iowa ranked last of all states in terms of psychiatric bed availability, with only 1.2 beds per 100,000 adults: this is a far cry from the national average of about 12 beds per 100,000 adults.”

And locally, an advisory group for Genesis Hospital was recently disbanded.

I invite all to make a difference: increase your awareness and become informed.

Three cheers for Mr. Hubbel who is running for Governor. He has a comprehensive plan. He had a person call to record my story.

Marlin Whitmer, retired hospital chaplain