The following commentary by Steven Sharfstein appeared in Psychiatry: Interpersonal and Biological Processes 68 (3) Fall 2005. I thought many of our ISPS members would be interested.
Brian Koehler
New York University
The Healing Power of Relationships
Steven S. Sharfstein MD
Past President, American Psychiatric Association
CEO Sheppard Enoch Pratt Health System
Harry Stack Sullivan, who practiced and conducted research at The Sheppard and Enoch Pratt Hospital from 1922 to 1930, celebrated the healing power of sustaining relationships. In his patient interviews, he almost always inquired about the patient’s “chums” as a way of understanding that human being’s capacity for interpersonal connectedness. Social psychiatry is premised on the here and now of such relationships, whether it be a therapeutic encounter or an everyday meeting in the community, school, workplace, street corner, shopping centers, and malls. Sustaining, meaningful relationships counter the existential problem of loneliness for all of us, and those who have suffered the debilitating experience of a serious mental illness require these relationships in the same way as individuals with pneumonia require penicillin [a reductionistic metaphor].
How can we study the healing power of relationships? The community mental health movement springs from the values and practice of social psychiatry (and Harry Stack Sullivan). This especially includes the Clubhouse model pioneered at Fountain House in New York, which combines psychosocial rehabilitation and supportive housing in the context of what has now been termed “recovery.” The President’s New Freedom Commission [unfortunately for this reader, this word "freedom" when used by our USA president implies something quite negative; I have a conditioned emotional reaction to its use by someone who has misapplied the term in such costly and perverse ways] on Mental Health bases its entire report on the concept of recovery as a process, often a lifelong process as well as an outcome.
Unfortunately, most mental health care has succumbed to a very acute-care model, mostly through managed care approaches that emphasize crisis intervention, and return of function. There is little value in the managed care paradigm given to psychotherapy or sustaining relationships. Utilization review would not have approved the group treatment of chronically ill individuals that I provided over an eight-year period in the 1970s. My group initially consisted of ten individuals with serious and persistent mental illness (mostly schizophrenia and some schizoaffective disorder) who had been hospitalized several times throughout their 10+ year careers as psychiatric patients and who were living in community settings. The site for the group was a local health center, and they met every Tuesday evening without fail. After an hour and 15 minutes of supportive group psychotherapy and an interchange involving the every day realities of life, I saw each patient individually briefly (5minutes) for medication management purposes.
At the end of 8 years, six of the original ten patients remained in the group. There were new patients who came and went. Several of the patients were living with one another during this time. All of the patients had my home phone number, but the members of the group were supportive to each other throughout the week, not just Tuesday evenings. The sustaining quality of our interactions, I am sure, was helpful in maintaining the patients’ efforts at recovery, keeping them out of the hospital. Even though the group has stopped now for more than 20 years, I still hear periodically from members of that group and know they are still in touch with each other. There was one patient in particular whom I’ll never forget. He would call every Tuesday morning to ask if the group was meeting that night. It got to the point where I would respond with such retorts as, “Did the sun rise today?” Finally after 8 years of group meetings changing only when I announced that it would end, he stated, “I just knew this would come, I was just waiting for it.” Sullivan stated, “We are more human than otherwise” Relationships, love, connectedness is what makes life worth living
