Care for people with mental illness involves 'grace and limits'

MANY FORMS OF MADNESS: A FAMILY’S STRUGGLE WITH MENTAL ILLNESS AND THE MENTAL HEALTH SYSTEM
By Rosemary Radford Ruether with David Ruether
Published by Fortress Press, $22

The Tucson shootings brought mental health issues to the public’s attention in vivid and compelling ways. Health care debates now include funding for people with mental illness as a matter of justice and safety. It is hard to find a better book to launch that discussion than Rosemary Radford Ruether’s Many Forms of Madness: A Family’s Struggle With Mental Illness and the Mental Health System.

NCR readers are used to Ruether’s insightful, provocative columns, her dozens of books on church history, ecofeminist theology and Jewish-Christian relations. But Rosemary Ruether on mental illness? What gives?

Rosemary and Herman Ruether’s only son, David, lives with paranoid schizophrenia. He is now in his 50s, residing near, but not with, his parents in Southern California. Rosemary, with David’s help and including David’s wonderful poetry, tells the story of his life and its impact on the rest of the family.

She spares us nothing -- the voices, the violence, the crises, and the endless search for help. David spent many years in progressive centers -- Duck Isle, Maine; Gould Farm in Massachusetts; Kahumana, Hawaii, among others. Between David’s specific needs and the high expenses, none proved a good fit for the long-term. He lives now in a kind of nursing home, but one wonders what is next, especially when his parents are gone.

Ruether describes how she wove David’s needs and care into her own prolific and productive career. The rest of the family -- her husband and two daughters -- are also part of the equation. She tells the story honestly without self-pity. This is Ruether simply using her well-honed analytic skills to try to bring about justice for more people for whom society provides very little. That one of them is her son adds poignancy.

With the same clear-eyed scholarship and fearless intellect that characterizes her work in religion, Ruether takes on the mental health system. She describes its shortcomings and the painful, expensive, sometimes dangerous results. For example, when David was between state-sponsored insurance coverage, his monthly expenses for medication were over $1,000. His parents are a safety net most of his peers do not have.

Public policies of “deinstitutionalization” result in many people with mental illness being on the streets. Ruether points out that options are limited. David does not require regular medical attention. Board and care options are few and far between. Many are not very savory. Most states have long waiting lists for suitable housing for this population. It is no wonder so many mentally ill people end up in jail.

The drug companies are major players in the shaping and understanding of mental illness. The medicalization of mental illness and its treatment is a given. Scant attention is paid to issues of environment or diet, for example. Some medicines when used over a long period of time might in fact worsen symptoms rather than make them better. Ruether makes the important point that it is hard to know whom to trust when even the National Alliance on Mental Illness, an important advocacy group, has received funding from pharmaceutical companies.

Ruether’s indictment of the mental health system is that it lacks vision. Even the best efforts are geared to maintain people rather than to lead them to recovery that she feels is their due. It is a long, and in many cases, unachievable goal. With hope and realism, Ruether calls recovery “the process of becoming a self-actualizing person in relationships.” At a minimum, this means providing educational opportunities, meaningful work, adequate housing, and medical/psychological support. Nothing less is just.

I found the spiritual advice most useful and applicable far beyond those who deal with people with mental illness. She calls it “grace and limits.” By grace she means that loved ones assure people with mental illness that they are committed to them for life. By limits she means that finite human beings can only do so much, even for their own children. The balance to be struck is a tricky one on a good day. For families living with mental illness it just got easier with this helpful book.

[Mary E. Hunt is a feminist theologian who is the codirector of the Women’s Alliance for Theology, Ethics and Ritual (WATER).]