The Influence of Community on Mental Health

Living with a group of people you are bound to run into some mental health issues. The National Institute of Mental Health estimates that over 25 percent, 1 in 4, of adults suffer from diagnosable mental health conditions in any given year. That's quite a staggering number. Our experiment in intentional communal living, with a philosophical basis of perfection (meaning, essentially, that we take the deliberate outlook that life is good), has yielded a much-reduced overall percentage and an ability to deal with many problems as they arise, within the group, often before the conditions become serious enough to require professional help.

If a condition isn't actually diagnosed, the situation is somewhat subjective - is a person a little unhappy or actually depressed? Are they trying to lose a few pounds or struggling with a full-blown eating disorder? Is it youthful rambunctiousness or Attention Deficit Disorder? Often the stigma and shame of having a mental health problem and the inevitable attempts to hide one's condition only exacerbate things.

Our community, Lafayette Morehouse, has been together in the San Francisco Bay area for over 40 years, averaging 75 to 100 people, and in that time we've only had two or three incidents of psychosis serious enough to require short-term hospitalization. There have also been a handful of varying degrees of depression - in one case serious enough to undergo long-term therapy. Also some cases of alcoholism, "ADD," drug addiction, Obsessive-Compulsive Disorder, and the like.

We have chosen to live very closely together, like a big family, and consequently, distress can't be ignored for very long. When you go through all facets of life's ups and downs together - marriages, divorces, births, deaths, cancer, broken bones, the whole range of human experience - episodes of mental illness are more able to be a part of life; not a taboo, but rather just another challenge to face together. We've found that openly handling issues of any kind makes life better for all involved.

Even in a long-term, loving, committed community, people face a variety of conditions - physical and mental. At times we've gathered together to "babysit" someone whose behavior warranted it; used alternative modalities, or encouraged taking the more traditional route of seeing a psychiatrist or getting other professional help, including temporary hospitalization until the person has been able to regain their balance. In that situation, community members are at the hospital as much as the rules allow so that our friend can be assured of our ongoing love and support.

How many of the growing number of ADD diagnoses are a function of weary parents looking for some relief? Among the dozens of children we had over the years, there were at least a couple who could easily have been diagnosed and given medication. We resisted saddling these young people with a life-long stigma and instead were able to increase the attention they received. In one of our most interesting lifestyle experiments, conducted over two generations, the kids lived together in their own house - sort of a kibbutz model but with different goals and motivations. Even with 24-hour adult supervision, they had a big hand in raising each other. Our system allowed parent and child to spend as much (or in some cases, as little) time as they wanted together. The kids also had a variety of role models to emulate, providing them with more behavioral options than in a traditional living situation. Those kids who were on the brink of being declared ADD? They're grown now, happy and productive, and only the stories remain of their younger days.

Whether a person is in crisis or has a chronic problem, we've found the most effective approach is to not lose sight of the person as a full-fledged human being. Just because they have a diagnosis or are behaving aberrantly, they are not defined by their condition. We have noticed that once a person starts getting treated as if they are a mentally ill patient, then they are no longer part of their group in the same way as a "normal" person and the separation intensifies their distress. An important part of supporting someone with a mental health issue is to keep them involved in the life of the group and not marginalize them by categorizing them as a victim.

In our decision-making system of one-no-vote, everyone has the power to cast an irrevocable no-vote that stops any proposed action. Knowing that you have a vote puts you on equal footing with others, confirms your power, and could help obviate some of the feelings of paranoia and worthlessness which are so often part of the basis of mental illness.

One example is of a long-time member of our group who was born with water on the brain. Through the tireless efforts of her mother and the help of cutting-edge doctors in the field, she achieved a relatively high level of functionality. At the same time she was left with diagnosed schizophrenia and is always on psychotropic drugs to help her maintain an appropriate mental balance. She owns up to her illness and is grateful to be able to get help in the parts of life she's not particularly adept at or comfortable with - she'll say, "you handle my money, I'm not good at that." Friends in the community take care of her medication and make sure she takes it on schedule.

Not having to resist her condition or pretend it doesn't exist makes being taken care of not a wrong part of her but just a part of her. Her condition actually seems to contribute to the sweet person she is. It certainly hasn't stopped her from having everything she wants and being a full-fledged, contributing member of the group. She has the same communal responsibilities as everyone else. If there's a task that falls within her interest and abilities, she volunteers enthusiastically. She takes care of others as much as they take care of her.

There are also times when she becomes somewhat delusional and angry. That's a signal that it is time to have her meds adjusted. It sometimes takes weeks before her psychiatrist is able to determine the next appropriate cocktail so we have to pay special attention to ease her way through these difficult periods. When we are taking care of someone who is on medication, we've found we have to consider that it's not the person just being unpleasant or "crazy" but that the medication may be having an effect - it's time to check with their doctor. Also, usually nothing is a permanent answer - what works this time may not work next year.

In her early 20s she wanted to have a child and with the support of the group, she was able to carry a pregnancy to term, even though it proved at times quite stressful to her and those around her as her hormones, fluctuating during pregnancy, affected seriously her mental stability. Nevertheless, she made it through her pregnancy, and has a fabulous daughter who, also with the support of the community, survived growing up with a single mom who was "different," and is a lovely and talented adult today.

While most children, particularly teenagers, are often ashamed of or embarrassed by their parents, she was exceptionally challenged by having a mother who wasn't "standard issue." While she was growing up, other people in the community often "filled in" for her mom when needed or accompanied them to parent-teacher conferences and the like. There was actually more than one person in the role of "mom," who helped to provide consistency and stability for the family. That ongoing help took a lot of pressure off of the relationship, and mother and now-grown daughter have been able to access and express the love between them. Despite all odds, a woman with a fairly serious mental health issue, who easily could have been relegated to an institution or lived life as a cripple, was able to be the good and caring mother she wanted to be. With community support, an illness doesn't have to hold back you or your loved ones.

The relatively low incidence of mental illness in our group may also be because each individual has more personal freedom to carve out whatever lifestyle suits them; to pick and choose what they do and don't want to do. That tends to take a lot of stress out of life and reduces the kind of emotional breakdowns that come from trying to cover obligations and responsibilities that don't necessarily suit the individual's particular nature. The challenges and demands of day-to-day life are distributed so that not everyone has to know how to cook or garden or fix things. We help take care of each other.

Friends are at hand to help when you are having difficulty with situations or people in your life. Parents are not on their own to nurture their children; spouses are not on their own to support and care for their partners. Friends are involved and interested in your wants and your successes and victories as well as being there for your downfalls and defeats.

Chronic illness, mental or physical, can be most overwhelming to the people closest to the stressed person, and can really wear them down. If you have friends who can help you, there's less chance for upset between the parties, less inclination to take it personally or to succumb to anger. If being a couple means you are solely alone or stuck with whatever illness your partner gets, whether it is cancer or chronic depression, it's pretty frightening. Having friends to spell you, help you, and possibly be more objective, eases the burden for the caregivers and reduces the guilt of the cared for.

Living closely with many other people allows us to share in more of life's joys than just our own. It also means we share in more problems than just our own. In our group we think of ourselves as responsible hedonists, and that means if someone is acting out in an inappropriate or self-destructive way we have to get involved because they are in our lives and their unhappiness affects us. So we take each other on for the good times and the bad times. And as far as we can tell, that results in more good times.