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, which cast into doubt the fundamental viability of liberal democracy. Many people wondered whether Western civilization itself was on the verge of extinction.
The burgeoning mental health profession hoped that the tools and concepts of mental health were just what was needed to 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.
Some 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 violence-drenched 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. Aurora (Colorado). San Bernardino.
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 seventy-fifth anniversary, the Hogg Foundation addressed this issue directly, by 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 the mental health 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—the language 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 a treatment, or for systemic mental health care reform.
To help us bring the higher ideals down to earth, we need to consider 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, and so forth. We need best practices and evidence-based treatment.
The problem comes, I believe, 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 conviction 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 1950s on behalf of the Hogg Foundation, spreading the gospel of mental health, even came to refer to 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 improve.
It was a noble and ambitious faith. And the work that has been done in its name has been extraordinary. We are the fortunate heirs of that work.
However, we’re also, I’ve come to believe, its unwitting victims. Although the path of mental health professionals and advocates of the 1940s and 1950s has produced enormous good, in many ways that approach 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 motivation 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 unexpectedly. 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 as it is now. 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 excessive.
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 definitive answers, in the sense that we sometimes like to dream there are. But we can strive to be courageous in our efforts to bring us closer to a truly loving society.