TeenScreen Truth

One of the greatest gifts I received during my three-year stay in the Philippines was the display of love, hospitality, laughter and warmth that is so typical of the Philippine people. When I went to celebrate Mass in the barrios or visit families and friends or meet with students and coworkers at the seminary or at Maryknoll Women’s College (where I also taught literature), people always had time for me and were most personable and cordial.

Social events did not always start on time because people and their needs were always more important than schedules or the job at hand. This made me realize how task-oriented and time-conscious–and often impersonal–Americans can be by contrast. I began to discover how I, as an American, was always so serious about checking my watch and getting down to business. The Filipinos were the first to teach me the meaning of the Oriental expression: “We don’t have watches; we have time.” They taught me to lighten up and laugh and take time for human interchange and affection.

Comparing Asian and American Values

After my first year of teaching at Our Lady of the Angels, I was asked to be chaplain for a small group of Franciscan college students who were going to Cebu City, the Philippines’ second largest city. These students would be taking summer courses at the University of San Carlos in that bustling port city, situated on the island of Cebu.

This gave me the opportunity to take some classes myself at that university. One of the courses was Filipino Literature in English, a course that was itself an insightful journey into the Filipino culture. (I would be teaching it myself the next semester back at the seminary. There I would have the perfect opportunity to learn about the culture from students who grew up in it.) The other was Filipino Values, taught by Lourdes Quisumbing, Ph.D., a well-known sociologist who later became Secretary of Education for the Philippines under President Corazon Aquino.

Professor Quisumbing’s class was largely a comparison of Asian-Filipino cultural values with those of the United States. I found her course spellbinding. Scales seemed to fall from my eyes as she explained the different sets of presumptions upon which American and Filipino approaches to life were based.

Here is just one example. Professor Quisumbing explained that in the Philippine culture–and in Asia generally–people grow up learning to face life together. Families are close-knit. They are expected to be emotionally interdependent–to meet life’s problems as a social unit. American culture, on the other hand, typically teaches its children to become emotionally independent as early as possible, so individuals can face life’s difficulties on their own. The American ideal is to prevail on your own–like so many of the heroes in our movies.

How true this rang to me! As I grew up in the United States, I was seldom pampered by parents, relatives or teachers. Theirs was a kind of tough love that taught me to face life with a stiff upper lip. I learned rather early to go hunting and fishing by myself In U.S. society it would not seem strange for me to go to the swimming pool or gym to work out on my own. There were frequently times in the Philippines, however, when I went somewhere on my own and was asked, “Where is your companion?” The cultural assumption behind the question was that human beings should be facing life together, not alone.

Thus my Philippine experience was teaching me to test and question my own cultural presuppositions. I actually learned to be less of a loner, to be more personable and openly affectionate and to see the value of family closeness and emotional support. I saw how the Philippine approach reflected the Christian ideal of being one body and bearing one another’s burdens. At the same time, I could still see the need for emotional independence, like that exhibited by the prophets and Jesus when they had to stand up against the crowd, even when abandoned by their own.

Without judging, Professor Quisumbing gave a multitude of examples of how American and Asian perspectives differ. Day after day this great teacher enlarged our cultural vision and understanding. She taught us, above all, to revere the different ways of the earth’s peoples. “To judge other cultures by your standards is insult,” she used to say. “To judge them by their standards is insight.”

Other Memories and Goodbyes.

I experienced both hardships and blessings during my three-year stint in the Philippines. Among the blessings, certainly, was the friendship and love of many Franciscan brothers and sisters, native Filipinos as well as colleagues from other countries.

One American friar, Max Hottle, O.F.M., of the California Franciscans, and I became fast friends and confidants. We were roughly the same age and of the same mischievous temperament. Max had a head start on me in understanding the cultural background of the Philippines. Trained in sociology at Manila’s Jesuit university, he had already been teaching social studies at the seminary for several years before I arrived. His often humorous and wry observations were always full of light, wit and fraternal warmth and were a medicine for my soul.

One of the highlights of our camaraderie was taking a motorbike vacation in the summer of 1971 through the mountains of Luzon to visit the famous Banawe rice terraces and other wonderful places. We fancied ourselves Asia’s answer to the American movie “Easy Rider,” a big hit all around the world at the time. The image of the film’s two hippies on motorbikes quickly became the running joke of our adventures!

As I look back on my time in Asia, I see it as a gift of providence and a preparation for my future work as a writer and editor with an interest in global issues. High on the list of things I discovered in the Philippines was this: Cross-cultural experience is another word for light.

Even before I went to the Philippines and was wondering, with some trepidation, what the future would bring, I had latched on to Psalm 121 as a consoling prayer for God’s protection. It often brought me comfort in my wanderings so far from home. Here is an abridged and adapted version of that psalm for all those who are anxious about what is coming next in their life’s journey. It’s also my prayer that God may always be your constant traveling companion:

YOUR GUARDIAN NEVER SLEEPS

God will not suffer your foot to slip; for the God who guards you does not slumber. The guardian of Israel neither slumbers nor sleeps. The Lord is your guardian and your shade, a faithful protector at your side. The sun shall not harm you by day, nor the moon by night. God will guard you from all evil; God will guard your life. God will guard your coming and your going both now andforever.

PRAYER FOR OPENNESS

God of all nations, do not slumber in your love for the Philippines and all the peoples of the earth.

Forgive the sins that we, shaped by different cultures, commit against each other through ignorance, weakness and inexperience.

Fill us with your all-embracing love and goodness that we may carry your kind of love to all races and peoples. Amen.

I LEFT THE PHILIPPINES with mixed feelings. It was difficult leaving a country that had given me so much and separating from friends whom I had come to love. On the other hand, I was looking forward to reuniting with family and friends in the United States after a three-year absence. I was also eager to begin a new phase in my Franciscan journey as a writer and religious journalist.

Well, being a writer was not entirely new. As a student, I had always been attracted–if not driven–to write for our Franciscan seminary publications. I had also studied creative writing at the University of Louisville and at Notre Dame and journalism one summer at Marquette. I had even experienced the excitement of seeing a few free-lance articles of mine appear in Catholic magazines, including St. Anthony Messenger, a national magazine published by my Franciscan province in Cincinnati.

In fact, during my last year in the Philippines, I had written an article on Pope Paul VI’s 1971 visit to Manila and on the state of the church in that country. The magazine’s young, visionary editor at the time was Jeremy Harrington, O.F.M., whom I knew personally, a fellow Franciscan of the Cincinnati province. He wrote me a few months before I was to finish my time in the Philippines and invited me to join the staff of St. Anthony Messenger. It all seemed providential.

The Journey Home.

The pain of leaving the Philippines was also muted by the excitement of the long trip home with stops in Thailand, India, the Holy Land, Greece, Italy, Austria, Germany, Spain, France, England and Ireland. The trip was exciting. Enough soul-expanding things happened to fill a book. I will just share one little out-of-the-way incident from that trip which had a special impact on me. It took place at the shrine of Our Lady in Lourdes, France. From my earliest years as a Roman Catholic, I had heard about this famous shrine and was drawn to it as toward a magnet.

As a young boy, I had seen the movie “Song of Bernadette,” which dramatized the appearances of the Virgin Mary at Lourdes. I still remember the scene where the young visionary, Bernadette, digs into the ground at the lady’s instruction only to see a miraculous spring of water issue forth.

A few weeks before my stop at Lourdes, a Catholic traveler told me to be sure to take in the bathing pools at the shrine. I had thought that only people with serious illness or disabilities were lowered into the spring-fed pools in the hope of being cured. “No,” she told me, “every visitor should experience these baths.”

My first night at Lourdes, I felt like a lonely pilgrim reaching out for the healing presence of Mother Mary’s love. What I was yearning for, I believe, and somehow sensed there in the darkness, was the maternal love of God, such as Yahweh promised through Isaiah: “As a mother comforts her child, so I will comfort you” (Is. 66:13a). I had always seen such love embodied in Mary, whom Catholics revere as the mother of God and the mother of the church.

It was damp, cold and drizzly the next morning when I went to the shrine’s bathing pools. An attendant kindly showed me to a small dressing room next to one of the pools where I could remove my clothes and wrap around my waist the denim cloth they handed me. Two attendants greeted me at the pool. The water, which came up to my knees, was cold. After reciting a gentle prayer, they carefully lowered me, back first, into the water. I expected the water to feel shockingly cold, but it seemed remarkably comfortable. They helped me stand up again and led me dripping out of the pool.

I was invited to get dressed and leave. It was not necessary to dry off, they told me. My clothes would not get wet. Strangely enough, after I got dressed, my clothes seemed perfectly dry. On more than one occasion since that event, other visitors to Lourdes shared with me this same experience of their clothes not getting wet.

But that is not my most vibrant memory of the experience. I can’t explain it, but after I got dressed and was walking away from the baths, I had an amazing feeling of innocence and new life. It was as if I was cleansed of all my sins. I felt whiter than snow! Although this experience happened more than 23 years ago, it remains as fresh in my memory as if it just happened yesterday. It was an inexplicable moment of light.

Whatever mixed feelings I still had about leaving the Philippines, whatever darkness or failure or guilt I felt in my heart, they were now replaced by healing and light–at least for the time being. I felt like a little child whose bruises or hurts had been kissed by an unseen yet loving mother. I was suddenly healed, and ready to resume my journey with a lighter step.

Home, But not Really Home.

I arrived back in the United States in the middle of the summer, 1972. I was home again. But I did not really feel at home. Yes, I felt happy to be reunited with family and friends. It was exciting visiting the offices at St. Anthony Messenger in downtown Cincinnati, meeting the staff and seeing my new work space. I had an inkling that I had found the right niche for myself and that I would ultimately be very happy in this new world of religious journalism.

Deep inside, however, I felt lost and broken. I had entered a dark place of emotional pain which, I suppose, had been put on hold during my meandering trip home as I moved from one distraction to another. Now I felt alienated from myself. Though I could enjoy my assignments, I felt that a core part of me was just going through empty motions.

A strong image kept coming back to me as a symbol of my emotional state at the time. It was the image of my heart as a broken stained-glass window. Though once standing secure and glowing with light, or so I thought, it now lay shattered and spread out in dark pieces on the cold ground. My identity seemed fallen apart, with no comfort in sight.

For one thing, I was suffering what they call “reverse culture shock.” I was no longer the same person who left the States three years earlier. My perspectives and identity had changed because of my Asian experience. I did not feel fully at home in my own culture.

I had also imbibed, I believe, the turmoil of a Catholic Church still rocking in the wake of the Second Vatican Council. The roles of religious men and women were evolving. Priests and sisters were leaving their religious communities to get married. Church rituals, traditions and outlooks were changing. All the familiar points of reference were gone.

Most of all, perhaps, I felt cut off and so far away from the love and support I had come to know from dear friends in the Philippines. On the American side, too, I felt abandoned by a special friend who I thought would be an emotional stay for me. My heart and self-esteem felt crushed and battered.

Sources of Comfort and Light

Fortunately, I could pour out my heartache and confusion before my confrere and confidant, Murray Bodo, whose wise and brotherly affirmation has always been a healing balm. Behind a mask of nonchalance, I carried on. Day after day, however, I kept tasting my cup of darkness and brokenness.

Somehow, I clung to the Good News that light and goodness are the ultimate reality, not darkness. Despite my pain I found joy in my writing, support in my Franciscan community as well as from coworkers, friends old and new, and family. I had to trust–on blind faith–that God’s light and goodness were still there above the dark fog surrounding my soul. Some day the fog would lift and the light would break through.

I recall finding light in the words of various authors and friends who seemed able to pluck hope from the ashes of suffering. I took heart, for example, in a line remembered from Ernest Hemingway. He had written that broken hearts are like broken bones: They get stronger in the broken places.

A quote in a letter from a dear friend in the Philippines also offered me the kind of light and comfort that helps one carry on: “Our human choice is not between pain and no pain,” she wrote, “but between the pain of loving and the pain of not loving.” I found hope in her caring words and in the truth they conveyed: As human beings we are not always free to escape suffering, but we are free to take a stand toward that suffering.

Like my dear friend, I, too, wanted to make my pain a “pain of loving,” which alone can give it meaning. On the other hand, nothing seemed worse to me than to choose “the pain of not loving,” that is, to undergo pain without any love or meaning in sight.

Another quotation that testified to the existence of hope in the dark pit of suffering was that of French writer Leon Bloy: “There are places in the human heart which do not yet exist, and into them enters suffering that they may have existence.” Bloy’s words helped me to hold on to the Christian belief that suffering can be redemptive.

Congressional conferees agreed last week to accept two amendments to a broader measure appropriating funds for two federal agencies.

Those amendments will  require:

* Employers with more than 50 employees to offer in their group medical plans the same annual and lifetime limits for treatment of mental illness and disorders as they provide for physical problems.

Group plans, though, could continue to offer different and higher deductibles and coinsurance requirements for mental disorders than for physical problems, while parity would not be required for treatment of substance abuse and chemical dependency.

In addition, employers would be exempt from this new, but limited mental health care benefits parity requirement if they can prove that parity will increase plan costs by at least 1%. There are questions, though, on how employers would have to prove that they are entitled to such an exemption.

The federal mental health care benefit mandate itself would expire on Sept. 30, 2001.

* Group health care plans to offer at least 48 hours of inpatient coverage for mothers and their newborns after a normal vaginal delivery and 96 hours of coverage after a Caesarean section.

Patients would be free to leave a hospital sooner, but that decision would have to be a mutual one of the physician and mother rather than required by an insurer or employer.

These amendments were included as part of a broader measure that appropriates funds for the U.S. Veterans Administration and the Department of Housing and Urban Development. Final passage of the measure was expected late last week or this week. President Clinton is expected to sign the bill.

Last week’s action ended weeks of suspense and an unsuccessful employer lobbying campaign that began after the two amendments were added to the appropriations bills on the Senate floor.

For some employer lobbying groups, there was bitterness over the passage of the amendments and fear on what it portends.

“What is disturbing is that Congress is willing to entertain legislation of this scope in the absence of hearings, or written records. It spells out an extraordinary danger to the employer community regardless of who controls the Congress,” said Mark Ugoretz, president of the ERISA Industry Committee in Washington.

The congressional action, Mr. Ugoretz said, is election-year politics. “This is election survival. This is typical of the feeding frenzy that occurs at the end of a session,” he added.

But advocates of the amendments put a different spin on the congressional action.

Sen. Pete Domenici, R-N.M., the chief Senate sponsor of the mental health care benefits amendment, said its passage “begins to move us out of the Dark Ages. . .and beyond the discrimination. It gets rid of a terrible stigma. It is a breakthrough for the mentally ill.”

Mental health care advocates also were jubilant. “This is a step toward elimination of discrimination” in coverage of mental health care services, said Russ Newman, executive director for professional practice at the American Psychological Assn. in Washington.

Backers of expanded hospital coverage for mothers and their newborns said its enactment will – appropriately so – leave medical decisions with the patient and her physician.

“The decision is appropriately placed where it should be and that is with the physician and the mother,” said Rep. Bill Thomas, R-Calif., chairman of the House Ways and Means Health subcommittee.

While employer lobbying failed to stop the amendments, it succeeded in narrowing the scope of the mental health care amendment. Sen. Domenici had originally pressed for legislation that would have mandated coverage equity for physical and mental health care benefits. Such a mandate would have increased group health care plan costs from between 4% to 9%, according to various studies.

The amendment agreed to by conferees falls far short of that. Employers still will be able to offer different cost-sharing arrangements for mental health care services compared with coverage for physical medical problems.

For example, employers will be able, as many now do, to require employees obtaining mental health care services to pay 50% of each bill, while requiring employees obtaining services for physical medical care to pay only 20% of the bill.

In addition, employers still will be able to direct employees to managed mental health care networks so that employees using the network will have lower out-of-pocket costs than those who go outside the network.

The legislation does however, bar the common practice of imposing lower annual and lifetime benefits for mental health care services compared to those for physical problems.

So long as employers can continue to manage utilization through networks, there should be little, if any, cost increase, said Joan Pearson, a principal in the Seattle office of Towers Perrin.

Congressional backers of mental health care benefits parity have said plan costs could increase anywhere between .16% and .4%.

Mental health care costs, which a decade ago were soaring, have been decreasing sharply in recent years as care has been better managed through medication and expanded use of day treatment rather than hospitalization, said Ms. Pearson.

The legislation does, however, exempt group plans from the mandate if they can prove that mental health care benefits parity increases plan costs by at least 1%.

While regulations will have to be developed to lay out how such proof or certification could be supplied, a congressional staffer said it wouldn’t be enough for an employer to provide a statement from an actuary saying plan costs would increase 1%.

Benefit consultants say the cost of the maternity provision also should be modest.

More than two dozen states already have imposed such requirements on commercial insurance companies and health maintenance organizations. HMOs, especially in California, led the drive – and triggered the public backlash – for shorter hospital stays, often dubbed drive-through deliveries.

“This will have only a negligible impact on health care costs,” said Woody McDonald, a Towers Perrin principal in Overland Park, Kan.

“Because the cost impact is so negligible, logic would dictate that this would not result in rate increases for HMOs in competitive markets,” he added.

Righting the wrongs of the mental health system is what earned Wesley Alcorn, who is president of the National Association for the Mentally Ill (NAMI) Consumer Council, the NAMI Wolf Award for 1998. The NAMI Wolf Awards were instituted six years ago to recognize those citizens who spoke up and challenged the mental healthcare system’s status quo.

Alcorn was in the audience when Dr. E. Fuller Torrey, director of the Stanley Research Institute, first explained the concept of the NAMI Wolf Awards. Named after the aggressive animal, says Torrey, it is awarded to a NAMI member who has been particularly effective and outspoken in trying to improve services for people with serious mental illness. It goes to one who has “raised hell,” says Torrey, rather than maintain a sheeplike demeanor.

That description befits Alcorn. In 1991, at the age of 32, he first entered the mental health system with a serious depression and panic disorder and was hospitalized at a public health facility for 18 days. He went on Social Security to get Medicaid coverage for his illness and was then released to day treatment at Montana House, a Medicaid-funded community treatment center. He describes the experience as like being in a dog kennel. Despite an $8 million annual budget, which he had to fight to see, he says, the place could not provide services as simple as a glass of milk; a lack of screen doors allowed patients to entertain themselves by counting fly kills, Alcorn quips. Alcorn pursued the problems of Montana House in the media, eventually getting the state to investigate the situation. The place went out of business, and the contract was given to another service provider. “It was a worst case scenario,” says Alcorn. “Disastrous. People died.”

Montana in 1991, says Alcorn, was a bad place and time to become mentally ill. The state had just deinstitutionalized its mentally ill, the last state in the Union to do so, and many patients were “dumped” into such community facilities. Indeed, says Alcorn, it was as recently as 1995 that services for the mentally ill were removed from the bailiwick of the state’s department of corrections. Today, Alcorn himself couldn’t get into the public hospital where his life was saved as they no longer take patients, and the only state asylum hospital has a completely involuntary patient roster which is tied to the penal system.

In response to these problems, Alcorn began putting pressure on the state’s federally funded advocacy group, Protection and Advocacy for Individuals with Mental Illness, whose role is to investigate allegations of abuse of people with disabilities. His stance, that the group is not protecting those that they were supposed to protect, got him kicked off the group’s board, and the ongoing struggle has produced several lawsuits. But his actions to publicize the problem also contributed to his winning NAMI’s Wolf Award, according to Dr. Torrey.

At the beginning of his struggles, Alcorn became aware of the state AMI association, becoming a rank-and-file member. He also used his background as a library clerk to volunteer to put together a library on mental illness to be made available throughout the state. He went to his first national NAMI conference in 1991, where Dr. Torrey gave him the motivation to become more aggressive. From there, he worked his way up until he ran the state AMI office for five years, still as a volunteer. Later, in 1995, he ran for vice-president of NAMI’s Consumer Council, composed of one consumer representative from each state, and the world’s largest group of mental health service consumers. He has, since 1997, been president of that council. Now, he serves as an inspirational speaker encouraging others to get involved in direct action.

According to Alcorn, the mental health system is so bad throughout the country that Montana can be seen to represent a microcosm of America in its treatment of the mentally ill. What has happened in Montana since 1991, he notes, only mirrors what has happened in the country at large in the last half of the century:

* The closing down of aging institutions without development of a community-based system.

* The closing of single-room occupancy residences due to gentrification, with the resultant rise of homelessness.

* The gutting of the public health system under the Reagan Administration, and the treatment of mental illness as a crime.

The rise of managed care, with the corporate sector privatizing care, using cost-benefit formulas that express threadbare human values.

From here on, says Alcorn, we are moving into the second generation of mental health advocacy, following the generation that saw the demise of the asylums and the first brave group of parents who formed NAMI. The next generation, he says, needs to turn to the strategies that produced the great social reforms of the 20th century, such as the civil rights and the women’s movements. Mental illness, says Alcorn, is the last bastion of discrimination, a biological condition as treatable and with the same recovery rates as physical illnesses if treatment is continued. Yet these patients have been frozen out of the healthcare insurance complex. It is much like the discrimination that affected African-Americans, he says, with the mentally ill denied access to mobility, education and credit; being routinely ghettoized; and made a collective receptacle of people’s fears. Taking as his role model Dr. Martin Luther King, Jr., Alcorn calls for nonviolent civil disobedience, such as marches, sit-ins, candlelight vigils and symbolic boycotts of the drug industry and of mental health facilities.

A good time to begin? Alcorn says October: Mental Illness Awareness month. Among steps he is calling for to completely remake the system: Recognition that there are gradations of mental health consumers, all with different needs.

Perhaps some 20% of mental health consumers need some form of long-term care and housing, with some way to monitor their therapy. For these, Alcorn recommends that all 50 states have PACT programs, or Program for Assertive Community Therapy, a caregiving approach that started in 1974 in Madison, WI, where consumers are given housing and receive daily monitoring visits. For the 3% who need a great deal of oversight, the need is for a treatment system, not a jail.

Alcorn finds himself in the middle ground of the debate on coercion, believing in the need for some forms of coercive methodology but stopping short of absolute control–i.e., to continue trying to balance the civil rights of the individual with the community’s need for safety. To those clamoring for tightening commitment laws, Alcorn acknowledges the need, but only if there is somewhere to send this population where they can be assured of receiving treatment and postdischarge assistance.

Alcorn hopes to use the Consumers Council to facilitate the integration of patients with their families, to get both groups working together on the same page. “It’s the best thing I can do for America, for NAMI and for consumers,” he says, considering it a part of the healing process that got interrupted when mental illness hit the family. But integration is harder than it might seem, says Alcorn, because the disease that strikes the patient strikes the family, and scars everyone. The family/consumer dyad in the council represents but an expanded dynamic of the entire parent/child relationship. It is especially hard on parents, he says, because it is their job to make the child autonomous, but it is also their duty to keep him safe–”a dilemma.”