Editor’s note: This commentary is by Sandra Steingard, M.D., who is the chief medical officer and a psychiatrist at Howard Center, where she has worked for over 21 years. She lives in Charlotte.
[T]he era when I was a young physician was one of great optimism for science and medicine. We were still riding on the advances made through the discovery of lifesaving antibiotics and the unraveling of our genetic code. We thought it was just a matter of time before most diseases would be conquered.
And that was the language, the language of war — conquering, vanquishing – that constituted our discourse. This discourse and the expectations that lay behind it entered the world of psychiatry with the notion that it was just a matter of time before we would find the genes that cause all of the problems our patients face, which in turn would lead to identification of the molecules – the drugs – that would erase their suffering.
My career began in the aura of this hope and optimism.
But there was a counter narrative, one that has deep roots in Vermont and was embedded in the growth of Howard Center during the 1980s and 1990s. It was the narrative of recovery. It was the narrative of social inclusion. It was the narrative of rights for people who had been marginalized and whose lives had been discounted. This narrative also told us that most people can recover.
We have since learned that there are things we, as health care and social support providers, families and communities, can do to dampen the hope upon which that narrative is founded and things we can do to foster it. We know that offering hope, helping people find a path of meaning in their lives, and improving social connections, and community acceptance will help people to recover.
The dominant medical structures in our world are predicated on the first narrative, the narrative of the victory of medical science and the defeat of human misery. Howard Center, while not ignoring the achievements of modern technology, is deeply imbued with the values of the second narrative, the narrative of recovery.
We are in the community helping people to live meaningful lives of independence, find jobs, succeed at school, and understand what drove them to use drugs or become entangled in the criminal justice system.
Something interesting has happened in recent years. These narratives have come together. The advances in science and technology have taught us that we need to think in a holistic way. We can’t conquer all infections with antibiotics because the bugs outsmart us. We are compelled to think about infections in the context of our environment. Studies of genes – especially in the area of mental health – have led to a deeper understanding of the complexities of how our genome makes us who we are, but for the most part not to cures. And the molecules – the drugs – we give people can be useful tools but they rarely cure.
As for the value of social connections? Finding meaning in life? We continue to learn about their power to heal.
Part of our work at Howard Center is to help people find their respective paths to recovery. We do this with hope and humility. Every day, we partner with people who make remarkable progress. Just as we have learned that we are not as successful at conquering disease as we had once hoped, we have also learned that the road to recovery can be a long, bumpy and circuitous one. Social inclusion, while laudable, takes work. Some of those on the path to recovery may cause discomfort and disruption. Whose responsibility is it to support them through these difficult times? What are the limits of the capacity of our community to support them? When should we intervene and remove individuals who are struggling from our communities, for their safety or ours? These are complex and often ambiguous questions. Consensus can be hard to achieve. When these challenges erupt into public view, the answers may seem obvious to those who are not immersed in the myriad decisions that those involved in this work struggle with daily.
At Howard Center, we grapple with these questions every day. We are in the community helping people to live meaningful lives of independence, find jobs, succeed at school, and understand what drove them to use drugs or become entangled in the criminal justice system. We help them find safe places to live. We are in their schools, their homes, our courts and the marketplace. We are so broadly embedded in the fabric of our community that we struggle to describe the breadth of what we do.
Are we perfect? No. My career has been one of repeated, almost-daily lessons in humility. But, we are always striving to improve. I continue to believe that we do remarkable work, much of which happens in the very private, quiet moments — the small steps toward creating lives of meaning that are deeply valuable, personal and important, but rarely the topic of the evening news.
