Dr. Mark and the Village

Mark Ragins, MD
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My name is Mark Ragins.  Most people at The Village call me Dr. Mark, except those who have known me long enough to forego that pedestal and just call me Mark.  I’m a psychiatrist, a story teller, and the kid who used to drive his parents and teachers crazy asking “Why?” unendingly and then, never satisfied with their answers, looked for my own answers and returned to tell them that their answers were wrong.

When I meet someone new I usually try not to tell them I’m a psychiatrist too soon.  There are so many strange and scary ideas about psychiatrists and mental illnesses out there that I’m afraid I’ll be rejected before I even have a chance.

Some people will suspect I’m crazy myself.  I must have become a psychiatrist to try to figure out my own problems or I must have had a disturbed family.  You can meet my family and decide for yourself, but to be fair you have to compare us to your own family, not the Cosby’s.  One very judgmental retired school teacher suggested to me, only half jokingly, that at 5:00 psychiatrists should be locked in the hospital along with our patients.

Other people will suspect that I have some special powers to know their deepest secrets; perhaps one of those third eyes in the center of my forehead that can see right inside you.  As it happens, I do notice things other people wouldn’t notice, like a contractor notices things about your house when he comes to visit or a park ranger notices things on a walk in the woods, but that’s not really that amazing a super power.

If I’m asked directly what I do for a job I will reluctantly admit I’m a psychiatrist.  I rapidly add that I’m not the kind of psychiatrist who sees people lying on a couch.  I work with people with severe mental illnesses like schizophrenia who would’ve been locked up in hospitals years ago.  I work with drug addicts on the streets and with badly abused kids who leave foster care at age eighteen with nothing trying to help them to make it in our world.  I work as part of a whole team working on getting them money, housing, food, some friends, even a job so they can be part of the community.  Sometimes that means getting them a Christmas tree and some presents to give to their kids.

That description usually changes people’s reactions.  That sounds like honorable work helping people who really need it.  Maybe I’m not sitting there psychoanalyzing my wife’s friends at PTA meetings.  “That’s good.  We need people like you to help them.”  But, their next comment is almost always, “That must be very difficult work.”  I tell them that it is hard at times, but that it’s very rewarding because many people do so well.  That takes them totally by surprise.  “I thought they never get better.”

Most of the people I work with have experienced an enormous amount of rejection in their lives, from schools, families, jobs, landlords, police, and even doctors.  Everyone “normal” would walk to the other side of the street to avoid the people I’ve spent my life with.  Maybe I am “abnormal in just that certain special way” that causes my heart to go out to them instead of rejecting them.  Maybe you are too.

One of my sons once called me a “crazy person magnet”.  We had just gotten off a four hour public bus ride across the high desert of Peru and I’d spent most of the time talking with the man next to me about his struggles with mental illness and substance abuse while he was in the army.  After returning from Vietnam he’d had a hard time, but he eventually recovered enough to be a peer-staff member helping other veterans in Massachusetts.

“Why do you talk to crazy people like that?” my son pleaded in a voice familiar to all parents who have embarrassed and somehow permanently ruin their child’s reputations.

“Because I’m interested in their stories.  I think that people who are different, who live on the edge, may see things that people in the middle can’t see.”

“No they don’t.  They’re just crazy.”

“Besides that, it’s not how I talk to people that’s unusual. It’s how I listen to them.  They tell me stories they’d usually keep hidden.”

He rolled his eyes, “So what.”

“And another thing:  There are a lot less ‘normal’ people in this world than you think there are.  You didn’t know he was a “crazy” person, whatever that means, until you heard him telling me his story.  You thought he was just another middle aged American tourist far from home.”

My son shook his head hopelessly and walked off.  He’s not going to be a psychiatrist.

I’ve spent over twenty years working at a very special mental health program, The Village, in Long Beach, California.  Over those years we’ve gone from being an exciting startup program to being one of the most respected and award winning mental health programs anywhere, but that description doesn’t really capture who we are.  I think we’re really the Island of Misfit People.

Remember the Island of Misfit Toys in “Rudolph the Red Nosed Reindeer”?  Rudolph had been rejected by all the other reindeer because of his strange red nose.  He couldn’t hide it no matter how hard he tried and “they wouldn’t let him play in any reindeer games.”  After wandering in a blizzard he ended up at the Island of Misfit Toys along with the Abominable Snowman, an elf who wanted to be a dentist, a Jack-in-the Box named Stanley, and a host of other misfit toys.  There they all accepted each other as fellow rejects.

It would be a stupid story if it ended there: Rudolph with your nose so bright, won’t you find a sanctuary to hide out in tonight?  Instead, in that atmosphere of acceptance, they began to discover their individual gifts and they each found unique niches and ways to contribute back in the real world.  The Abominable Snowman puts the star on the Christmas tree, the dentist elf fixes a toothache, Stanley finds a little girl to play with him, and Rudolph leads Santa’s sleigh through the fog.

The Village isn’t a place to live.  It isn’t a place to hide out.  It’s a place to be accepted, find your gifts, and participate in the community.

Most of what we’ve learned at the Village can’t be simplified as proscriptive lists of “The Eight Steps to Overcoming Mental Illness.”  They are nuanced, messy, relationship-based, hard earned wisdom.  Often it runs contrary to what we’d heard and what the experts taught us, but it makes sense, it connects to people’s actual experiences, and it works.

 

24 COMMENTS

  1. Thank you, oh thank you for this! I don’t know how I’ve missed knowing about things like your program, like this website, like these people here who actually understand! Well, no, I do know how–in the thirteen years since I got off psychotropic drugs and began a “real life” I have assiduously avoided anything connected with mental illness, the mental health system, consumers, survivors, or anything else wearing an even remotely mental-health-related label.

    It must be time for me to reconnect, because I keep getting blown away by the stuff I’m reading here on MIA since I joined a few weeks ago. I find myself crying–full-on head-on-the-table alarms-the-dogs sobbing–with nearly every blog post.

    How different might my life have been if I had found a “place to be accepted, to find [my] gifts, and participate in the community”? It doesn’t matter, of course, because my life has been as it has been and I have learned a tremendous amount from it. I wouldn’t change a thing…but oh, I would welcome a community where I could talk about my experience and share my grief and pain and also my hard-won wisdom. Places like that seem to be pretty thin on the ground around here where I live. Guess I’ll just keep reading 🙂

    But anyhow, Thank You. Thanks for caring, for understanding, for making a difference.

  2. Hi Dr. Mark,

    I’m curious what you think about Open Dialogue in Finland. I believe close to 85% of young adults who use this program fully recover from psychotic difficulties. I also wonder if you address trauma in your services. I have read that over 90% of people with more serious psychiatric diagnoses have been victims of physical, sexual or verbal abuse.

    In addition to this, I’m aware that many people can and do have robust recoveries from diagnoses like schizophrenia and bipolar disorder, but when they return to their lives they usually don’t share their stories, probably because stigma is so pervasive in our society. Therefore, providers only see and study those people who are still having more difficult experiences and/or have become stuck in services that have created hopelessness and dependency. This creates what has been called the “Clinician’s Illusion,” which is the sense among providers that these diagnoses have a negative prognosis when in fact, this is not true, but may become a self-fulfilling prophecy.

    Thank you for your work and for sharing what you do.

  3. “and with badly abused kids who leave foster care at age eighteen with nothing trying to help them to make it in our world.”

    And surely most if not all of them had been forced to take “antipsychotic” drugs in the years they were in foster care, and were probably left stuck on them as adults. What is your role in that?

    I ask because you seem to be introducing yourself, claiming a reluctance to admit you’re a psychiatrist because of the perception of psychiatrists as leather couch psychics. Psychiatrists have absolutely nothing to be ashamed of for the inaccurate depictions of them in the media throughout time as talk therapists. It’s the drugs, and particularly the 1+ million children being forced to take drugs proven to cause serious brain damage, that is the concern. You didn’t address that at all. There wasn’t one mention of drugs in any context in your whole post.

    So, I ask, why not? What is your opinion of the drugs? Do you prescribe them? Do you force/coerce people to take them? Do you help people to get off of them?

    • Dr. Mark, welcome. It’s a treasured and rare experience for me as a survivor to have open discussion with a psychiatrist about things that are important for recovery. Your writing here and on the Village site leads me to view you as a thoughtful and caring person.

      As to issues of drugs and their prescriptions, Dr. Mark has written several documents:
      http://mhavillage.squarespace.com/storage/46CanIRecoverandGetOffMyMedications.pdf
      http://mhavillage.squarespace.com/storage/44ThoughtfulPsychopharmacology.pdf

      If I may be so bold to place Dr. Mark on a continuum from only drugs as treatment to conservative/no drug and social support, then Dr. Mark’s approach is more like Open Dialogue than most other approaches in the US. But, perhaps, he depends a bit more on continuing existing drug regimes for his patients than on reducing the drugs. Here’s a quote:

      “If we offered services besides medications, if we didn’t require people to be on medications before we helped them with housing or employment or benefits, if we supported people while they were trying to get off medications and learned to rely on emotional and interpersonal help, maybe we’d have more people in our clinics who could get off medications. But, we’re not doing any of those things”

      Dr. Mark, it is wonderful to see psychiatrists who question the mainstream medication management approach. You clearly value psychosocial supports for patient recovery. But, don’t be surprised if people here, myself included, wish to persuade you that the drugs are more detrimental, have worse withdrawal, and have more side-effects than you think.

      • I think I misrepresented that previous quote… I think Dr. Mark was speaking of the ‘we’ being the general approach in the US. Later on he says this:

        “What we’ve found when we offer sanctuary and hope and belonging and empowerment and self responsibility and meaningful roles is that some people do recover. Some never take meds, some start only after years of refusing or stopping and starting, some stop meds after years of taking them. Frankly, whether they take medications or not, isn’t our main concern if they’re achieving their goals and building a life. I don’t know what the percentages are because I do clinical work, not research, and besides I never know who the people being researched really are or what they’re getting. But I do know that the National Empowerment Center’s interviews are real and that Courtney Harding’s studies are real and that some people with schizophrenia can recover with or without medication.”

      • “If we offered services besides medications, if we didn’t require people to be on medications before we helped them with housing or employment or benefits…. But, we’re not doing any of those things”

        So, yes. He forces/coerces people to take drugs in order to receive services. I consider that especially atrocious when considering the young adults who are coming from years of forced foster home drugging. Now they turn 18 and are so messed up from years of neuroleptic drugs that they need SSI or housing and then the professionals wont work with them if they’re not taking the drugs that screwed them up in the first place. I would have killed myself if I wound up in that situation. I’m not sure if I am thankful or not, but I had family support when I was turned down for services for refusing to start taking the brain raping chemical lobotomy drugs that ruined my childhood and ultimately my life.

  4. ” a story teller, and the kid who used to drive his parents and teachers crazy asking “Why?” unendingly and then, never satisfied with their answers, looked for my own answers and returned to tell them that their answers were wrong.”

    You’re my twin! And now, for the story.

    I was purely serious when, at around kindergarten age, I asked my birth mother “why is there a world?”. I needed to know. She laughed (and many years later I knew why – I knew what she was thinking and what she believed the answer to be). Proudly, I now know the true answer to the question of “why is there a world” and I can also answer the question of “what is nothing”. I got my doctorate degree in Thinking from the school of Solitary Confinement (and booted out of the master’s program for Hilarity at the school of Clowns).

    “One very judgmental retired school teacher suggested to me, only half jokingly, that at 5:00 psychiatrists should be locked in the hospital along with our patients.” LOL

    “One of my sons once called me a “crazy person magnet”.”
    I wonder if the two of you could enjoy listening to this together: http://youtu.be/fClwusLryq4

    *smiles*

    ~ mjk

  5. Isn’t Dr. Ragin the guy who SAMHSA appointed to refute Bob Whitaker at the “Alternatives” conference in Anaheim?

    This “I’m just a regular guy” article seems very strange. If I were a decent psychiatrist and I wanted people to feel positive about me, I would just write about the things I’ve done or the positions I have on issues.

    • Yes, I was there for that Alternatives rebuttal / riot. I think all people who read Whitater’s stuff go through a period where they want to rebut it. I was in that exact stage myself at that conference till I got to talk to Bob and look more at the data myself. I have a blog about why psychiatrists have a much harder time accepting Bob’s data than people in recovery. http://wellnesswordworks.com/mental-health-outcomes/

      Some of the points were good, like 10 reasons people besides overmedication that people don’t recovery. But at that talk Ragins didn’t really address the data Whitaker uses because he said he hadn’t real the whole book yet. Funny, trying to rebut data you don’t know. Wait, that’s what the vast majority of pychiatrists do every day. Sad that most pyschiatrists don’t even know the academic literature in their own field.

      • Thanks for posting this clarification of Ted’s timely and polite reminder of Dr. Raglin’s history. Corinne, since you weighed in, I am listening to this threaad with interest. Without Ted’s fact check I might have mistaken Dr. Raglin for the type of treatment provider that I would want for my adult daughter, but Corinne, you are the ultimate diplomat and brought me back in. Go bike riders!

        I wasn’t at Alternatives but i am grateful to peer activists who continue to apply pressure to SAHMSA to tell the entire story about thr role of medication in mental health recovery, including the sordid economic and political history of how medication came to be the standard of care for schizophrenia (psychiatry isn’t the only type of medical practice to become hopelessly entangled with commercial interests), the possible link to medication withdrawal and violence/agitation, the failure to adequately monitor or recognize medication cauded side effects, the truth that disabling the dopamine system in the brain does not ‘cure’ psychosis as the term ‘anti-psychotics’ falsely implies (although it can do wonders to sedate individuals thereby being a boon for those whose main concern is social control, not full recovery) and how conveying this to most psychiatrists only causes psychiatrists to become upset, the failure to adequately compensate victims who have permanent physical damage caused by medication, the abysmal lack of research funding to develop needed protocols and support systems to help individuals taper safely off medications, the abysmal lack of alternatives for first-timers until it is often too late (until permanent damage is done to patients so they cannot live independentaly without millions of dollars of social services) or until individuals become so psychologically dependent on those who label and medicate that they csn no longer envision a life of independence off meds.

  6. Ragins will also be having a dialogue with Whitaker at a confernce in Burbank, CA in a couple of weeks. The hope is that by getting all the parties talking, we can better advance changes. While SAMSHA may have wanted a rebuttal to Whitaker at Alternatives, that’s not what they got in Ragins.

  7. As a fellow blogger, and survivor/carer activist from Scotland, I also wanted to say “welcome Dr Mark”.

    I liked the Village and Build your own Box websites, the ‘core gift’ philosophy. It’s got a collective aspect alongside valuing the individual, a real community development approach, something I’ve believed in for over 30yrs.

    All the best, Chrys

  8. A member of the island of misfit toys, yes, I remember feeling that way in December of 2005, as I was being weaned off the last of a couple combinations of six different mandated psychiatric drugs, with up to 15 moderate and major drug interaction warnings stating these meds cause the known drug interaction issue anticholinergic intoxication, which psychiatrists call “bipolar.” And at the time, I had just started reading the medical records I’d just picked up, which stated the psychiatrist who’d been claiming his drug induced anticholinergic intoxication was bipolar had rationalized his egregious miss-medication by claiming my name / identity was “irrelevant to reality” because he thought I was “w/o work, content, and talent.” But he’d also based all his beliefs on who I was, soley upon lies and gossip from people who’d raped my child and wanted to cover that up, and misinformation from a PCP who wanted to cover up her husband’s “bad fix” on my broken bone. It’s a story of how an unethical medical community makes someone feel like a member of the island of misfit toys, that is my experience of what the psychiatric industry is. People who defame and make patients sick, to cover up prior easily recognized iatrogenesis, and child molestation, for profit … After promising to “first, do no harm.” Can you say hypocrites?

    But I do thank God for a little boy, who said, “I want to be a dentist.” Because I did suffer withdrawal from the prior anticholinergic intoxication / “bipolar,” which was of course misdiagnosed by subsequent psychiatrists, resulting in more forced medication that was also a “Foul up.” But the boy who wanted to be a dentist, grew up, became a dentist, and saved me from the psychiatric industry that believes no one on the face of the earth can ever be made sick with psychotropic drugs. This dentist told me his name was the French word for “future fisher of men.” I will say, thank you Dr. Pescheret, for being my savior from a psychiatric industry insane enough to believe the psychiatric meds can never make anyone sick. And I do pray the psychiatric industry stops making patients, especially the millions of children they stigmatize with made up disorders, feel like members of the island of misfit toys.

    But, Dr. Mark, I do believe “it takes a village.” But it takes a village of ethical people, trying to help each other based on listening to each other and respecting each other. Not a village with some members having delusions defaming people with made up diseases, and rendering them senceless with toxic drugs for profit, is “appropriate medical care.” Forgive me, hopefully some day I’ll stop being disgusted by a psychiatric industry that is still covering up the fact they’ve turned over a million little children into bipolar / schizophrenics, completely with drugs. In the exact same way my unethical former PCP covered up her husband’s “bad fix” and my misdiagnosing therapist covered up the molestation of my child, by friends of hers. Misdiagnosis and complete and lack of ethics, a pastor was kind enough to confess to me was the “dirty little secret of the two original educated professions.” Shame on the medical and religious professions for being bought out by the psychiatric industry’s ability to defame and render senceless patients to cover up your mistakes. Power corrupts, and absolute powers corrupts absolutely, doesn’t it? And money is the root of all evil, right psycho / pharmaceutical industries? Just an FYI, repentance is the proper reaction, if any within the psychiatric industry ever want forgiveness. And thank you from the bottom of my heart to those outside, and especially within the psychiatric industry, pointing out the truth. You, too, are heaven sent.