Thursday, October 25, 2018

Geel, Belgium

Saint Dymphna

Sorry for the delay, but my post of October 1 was meant as an introduction to this one, about Geel, Belgium.

I have known about Geel for some time, but NPR did a story recently and it reminded me about Geel, and about my friend, Greg.

Geel is a small farming community in Belgium that has a unique custom of caring for the mentally ill in people’s homes. The tradition began in 1480, after the death of a nun, Dymphna, an Irish princess who had fled to a convent in Geel to escape from her father who was “mad.” As a nun, Dymphna had special compassion for the mentally ill and she cared for them in her convent. Her story ended when her father followed and murdered her. She was canonized after her martyrdom, and then families began make pilgrimages to Geel with their mentally ill relatives. Eventually there were too many for the convent to handle, so instead of turning them away, people in the community took them in.

It’s a remarkable story, not just as evidence that human kindness still exists in this contentious world, but also because the system still seems to work, after 500 years! Now the process has been modernized. Guests are screened by doctors, prescribed medication when appropriate, and assigned to families. They help their host families or have jobs, and the government provides a small stipend. Some of the guests act out, depending on their diagnosis, but they are accepted by their families and by the community. According to the reporter, the host families were surprised by questions about whether their guests are a problem. The average length of stay with a family is 28 years!

The NPR piece described several examples of families’ relationships with their guests. One man twisted the buttons off his shirt every day, and every night his host would sew the buttons back on. When the reporter suggested that the host use tougher thread to save herself the trouble of her nightly repair job, she was shocked. She said, “He needs to do this.” A man with hallucinations about being chased by lions was satisfied when the host pretended to chase them away.

There were examples of violence, of abnormal sexual behaviors, and in each case the host families found ways to adjust. Both hosts and guests interviewed described themselves as being happy with their arrangement.

Several studies have been done trying to explain what makes Geel’s system work, without any real success, but one factor seems be the attitude of the host families. The guests are accepted as they are. The hosts aren’t embarrassed by them. They don’t try to “cure” them. They don’t even think of them as abnormal. This explains one of the rules for assigning guests to families. No one is assigned someone from their own family.

The reporter did look for other examples where acceptance of mental illness is practiced. It’s a little hard to replicate Geel, because they have a  long tradition, everyone in the community understands and accepts the situation, and the community is rural and there are a lot of ways for someone to be useful without fitting into traditional occupations. She did find a woman who has been managing an apartment house in a US city, trying to replicate to situation in Geel, with some success.

Which brings me back to Greg. I’m certainly not any more accepting, or more broad minded than average, but Greg and I got along fine. And maybe Geel's principals of acceptance should apply not just to differences in behaviors, but also to differences in opinions and beliefs, 

We can all learn something from the people of Geel. 

Tuesday, October 2, 2018

Accepting People as They Are

During my last year in medical school I roomed with a guy named Greg. He was the brother of a friend of mine who had moved to New York to attend Union Theological Seminary. Greg had lived with him until he got accepted to Union and he didn’t want Greg to have to live by himself. I was kind of tired of being alone in my apartment anyway, and it was nice to have someone to share the rent.

Greg was several years older than I, but we got along fine. He was neat and had a  pleasant personality. He wasn’t opinionated and didn’t have any rowdy friends. He was taking some classes at Central State University in Edmond, Oklahoma, so both of us were busy, and we both studied in the evenings. There was something unique about Greg though. He was paranoid schizophrenic.

Greg’s brother didn’t actually tell me much about him, so I didn’t know much except for his diagnosis. He had done some outlandish things in the past. He told me that he had once walked down Main Street in his underwear brandishing a pistol, but at the time I knew him he had learned how to control his behavior, and he was on a big dose of Thorazine, I think 800mg a day.    

I didn’t notice anything very unusual about Greg. He was very open and would talk about his history or his experiences if I asked, but I didn’t pry. I didn’t want him to feel uncomfortable.

Greg didn’t drive, so if he needed to buy groceries, go to the laundromat, or just get out of the apartment, I would take him, since I had a car. He rode the bus to school. When we went out he would glance around at the cars behind or beside us. When I asked why he said that he thought someone was following us. I reassured him, but he kept looking around anyway.

The other thing Greg did that was unusual, especially in those days, the early ‘60’s, was listen constantly to a little radio he carried with him every where he went. When I asked him why, he told me that it was to drown out the voices. It was then that I started to realize how miserable he must be, having to listen constantly to hallucinations. They weren’t just the ordinary daydreams either.  They told him that he was in danger, that people were plotting against him, and it was hard for him to ignore them, hard not to believe them, even though he knew logically that they weren’t real. He would tell me sometimes about the voices, I think just to get me to reassure him. 

Greg was kind of childish. He not only relied on me to help him fight against his hallucinations. I also helped him to establish a routine. I got him up in the morning, helped him with his breakfast. He told me his schedule so I could make sure he got to class on time. He was having trouble with his weight, so I put him on a diet, which he followed to the letter and lost twenty pounds in a month. He wasn’t stupid. He was just constantly distracted. I can’t imagine what it was like for him.

Greg and I roomed together for a year and then I left him. I went to St. Louis for my internship. After a couple of months I heard that he had killed himself. He got in the bathtub and dropped a lamp in the water. It still hurts when to think about it.