Archive: Dispatch from the Trenches of Public Mental Health

Archive: Originally posted at Democratic Underground on 12/18/12

As a preface, the discussions on mental health this week have gotten me where I live. On April 20, 1999, I was working a few counties away from Columbine High School, in the juvenile division. I had several clients who were either expelled or suspended from school in the days after — not for anything they did, but for being different, under care, or just part of the geek/goth sub-culture. My clients bore the blame for the actions of others, and that blame did not help anyone — not community, not clients, not the victims. I’m seeing that exact same pattern again. We have done this, and the collateral damage endures.

These are my experiences — the stats have probably changed since my colleagues and I last compiled our numbers, but they haven’t changed much, and in many cases, not for the better. I don’t have accurate numbers for 2008-forward, but given the slashing state, county and city budgets have taken, I’m not hopeful for better.


I used to be a clinical psychologist in public mental health. Burn out is the brontosaurus in the living room. Here’s a snapshot of the trenches. The average public mental health clinician has been in the job for less than five years, and has been licensed for about the same amount of time. They’re mostly young and new. 65% leave public service for either private practice or get out of the field entirely. I was lucky — I had excellent scholarships and fellowships through grad school, but some of my peers self-financed and left grad school with debt they will be paying until they hit Social Security age. Starting salary at the county level (which is the majority of public mental health clinicians) averages less than the average first year public school teacher. (A psychologist, by the way, usually has 7 years of post-secondary education; a K-12 teacher has 5-6.) We don’t have a union. In some counties, we’re not even employees — we’re contractors, so no benefits. We don’t go into psych for the money — we’re there because we want to help others. And it kills us — we’re 3 times more likely to commit suicide than our peers. We’re 6 times more likely to be on anxiolytics than the general population.

In my last year before going back into research, 95% of my clients were court-ordered. The few who were there voluntarily were as compliant as their circumstances allowed, but a court order drops compliance by at least half. A therapist can’t help a client who doesn’t want help, and often clients work against court-ordered therapy. For the court-ordered client, the therapist is the avatar of a power structure where the client is entirely disempowered. The therapist seems to have the power to send a parolee back to prison for a beer or mouthing off, to place zir children in foster care, to force them to abandon anyone we determine to be a “bad influence” — which in a lot of cases, means most of the client’s social network. In most counties, the client is forced to pay for this. In most places, public mental health services are set up to fail comprehensively. I worked in a red county, and believe me, the county board of supervisors wanted us to fail. If we failed, they could stop paying us liberal commie bleeding hearts and just send all that human garbage to rot in prison (and that prison made a lot of the local power structure a lot of money…)

Our clients’ median household income was less than half of the local median household income. Poverty makes compliance harder.

Pop quiz:
Go to therapy or go to work — when skipping either violates parole?
Buy court-ordered meds or buy food?
Use one’s 9th grade literacy skills to write in one’s therapy journal or get an extra half-hour of sleep after a triple shift?
Pick two: rent, therapy, or kid’s root canal?

Clients have a lot of dreadful algebra every day. For a lot of my clients, poverty was both the cause and effect of their dx. Public mental health made me a socialist — fix the social safety net and half of the client load vanishes because half of the client load is situational. If every kid has enough to eat, safe and comfortable housing and an effective school, if every adult has safe shelter, valued, meaningful work and sufficient leisure, depression and anxiety plummet. It’s not a panacea, but our deficits in the safety net magnify our problems.

I spent most of my time in the trenches deeply worried about my clients — I took it home with me every night. If a client was non-compliant and I reported it, my client could have gone to prison (or gone back for parole violation), which ends any hope of effective treatment. Non-compliance can mean anything from skipping appointments to not doing the work to skipping meds to self-medicating. I was supposed to report every beer, even with clients who had no addiction problems. Do I report someone because zie blew a long-bald tire or got a chance to work extra hours so zer kids actually got new shoes, but can’t call to reschedule because zer boss doesn’t allow personal calls (or maybe doesn’t know zie’s in therapy — people still get fired for mental illness, especially in right to work states)? If I didn’t report it, that’s my license… And possibly a suicide, or domestic violence, or a relapse. Believe me, that stress eats therapists alive.

Without a license, my master’s degree won’t get me a job at a call center or flipping burgers. But pissing off a client by reporting non-compliance earned one of my colleagues a severe beating. I had my tires slashed (which were bald, but I couldn’t afford to replace them.) I was salaried, scheduled for 30 one-on-one appointments a week, plus 10 hours of group, plus 75 welfare calls (6-12 hours), plus on call for 24 hours a week. Yes, 70-80 hour weeks, for which the county paid us $27K a year plus medical and dental (but I couldn’t take the time off to actually see my doctor or dentist…) Unlike teachers, we don’t even get summers off. The year I left, the county I worked for cut 3 of the 27 positions and the county judges ordered 21% more therapy. Which meant worse service, worse outcomes, more recidivism, which gave the county board of supervisors more incentive to cut the budget.

This country doesn’t care about public mental health, either the clients or the therapists. We’re first responders — and the first rule of first response is don’t be a casualty. I was terrified I was going to kill myself, or screw up so badly that a client or someone else got hurt. I cried every night for three years. I am in research now so I have the energy and time to fight for better conditions for clients and colleagues. I still have 80 hour work weeks, but half of that time is lobbying on their behalf. It’s the only way we’ll ever change it. Public mental health is like juggling burning napalm.

Archive: Baptizing Dead Quakers

Archive: Originally published 05/28/2011 at

Baptizing Dead Quakers

Zenobia Faraday Harris [1] was born in 1707 in Offton, Suffolk. A Quaker, she immigrated to Pennsylvania alone in 1735. She married another Quaker in 1739. She had three children and died in 1790.

She’s my several times great-grandmother, and that’s all we know about her. We don’t know where she lived or was buried or who her parents were. My mother’s family has about four hundred years of these records because Quakers in England and English possessions had to maintain their records before the various Toleration Acts. Until the 1753 Marriage Act, England did not recognize Quaker marriages. To be legally married, Quakers had to go to their local Church of England official. Many did not, nor were their children recorded in the parish records. This would be equivalent today to requiring a Methodist to be legally married in a Catholic church, by a Catholic priest, and for a child of two Methodists to have to be baptized by the local Catholic parish to have a birth/baptismal record.

Consider the recent kerfluffle in the US over birth certificates — the issue wasn’t much different then. Early Quakers who refused to conform faced serious practical consequences — Quakers were legally illegitimate in a time when legitimacy defined one’s ability to hold public office, inherit, receive emergency charity, or occupy land; a Quaker woman was legally unmarried and could be whipped and/or fined for unlawful cohabitation. That such laws were irregularly enforced during Zenobia’s life did not mean that it couldn’t, didn’t or wouldn’t happen. Religious freedom was a privilege, not a right. This may have been one reason Zenobia immigrated.

Fast-forward to 2011. Our records have never been compiled, published, nor to my knowledge, been outside the family, save for those which became part of the public record. We’re neither important nor wealthy. I find these records interesting, especially the 17th and 18th century records, but I’m a history/research geek. Neither genealogy nor colonial American history are my interests, so I haven’t been involved in the family archives.

Several weeks ago, my sister Lou got a photocopy of the Quaker family documents from the staunchly Quaker family archivist and called me to ask about OCR software to scan the records. My sister is not history-minded. Further, she’s busy with two sons and a master’s degree in progress. Genealogy is not a hobby that can be done in five minute chunks.

It took me a minute to realize why she cared. Lou is a Mormon convert. Her conversion about seven years ago didn’t surprise me much, nor did it cause much family stir. We’re a pretty tolerant bunch, as families go. Mormons have a strong interest in genealogy because they believe that souls cannot fully access the afterlife unless they have fulfilled certain obligations on Earth, or someone has fulfilled them on their behalf. These obligations include Mormon, and only Mormon, baptism. Mormons believe that one of the conditions for the Second Coming is ensuring that every soul who ever lived is baptized. They do this through a ceremony of proxy baptism in which living Mormons are baptized in the name of those who died without benefit of Mormon baptism. Mormons also believe that their own exaltation depends in part on ensuring that their ancestors are baptized.

The nature of genealogy is an ever-widening progression — one person has two parents, four grandparents, eight great-grandparents and so on. Start throwing siblings, children and family-by-marriage into that mix and records can quickly become as tangled as a plate of spaghetti. Determining who is responsible for family records and inheritances is tricky, even in amicable families like mine. Mormon genealogy further complicates this already complex situation because Mormons don’t just work up the family trees. They submit for baptism direct ancestors (grandparents and N-great-grandparents), co-linear ancestors (N-great-aunts and uncles) and descendants of co-linear ancestors. There’s a big reason hobbyist genealogy only took off since the invention of the personal computer — genealogy databases are massive.

Quakers do not believe in baptism by water. For Quakers, accepting baptism imperils their immortal souls. That’s been a major Quaker doctrine since the 17th century. The Quaker branch of my mother’s family is rather rare in that it has been consistently Quaker since the 17th century. Most contemporary USians with colonial ancestry are not still Puritan Anglican, Wesleyan Methodist or Dutch Protestant. But that doesn’t mean there aren’t living and dead Quakers in Mormon family trees. There are instances like Lou, who converted; that’s been happening for the 180 years that the LDS faith has existed. (Several early Mormons were originally Quaker.) Just because one set of great-grandparents converted doesn’t mean their siblings did — and because Mormons consider both trunks and branches to be part of their family trees, people of all faiths become part of the LDS family archives.

Everyone in our Quaker records consciously and willfully refused baptism by water. Historically, some Quakers who refused baptism were tortured, fined and/or exiled from their communities. Some were executed. At the very least, such refusals made their lives more difficult. While none of my ancestors were, to my knowledge, executed for heresy, some three hundred left England for Pennsylvania.

I had to think fast. “Lou, I know you’re pressed for time. Why don’t you send me the records?”

After the records arrived, I started asking some careful questions of Lou and Charity (our Quaker archivist) both. Lou did not tell Charity why Lou wanted the records, nor has anybody bothered to tell Charity that Lou converted. (Lou and Charity are not close; Charity and I are, but Lou’s faith isn’t my business.) Lou did know that if she told Charity why she wanted the records, Charity probably would refuse to send them, and Lou admitted to deception by omission to get what she wanted.

I must admit that I’m stalling Lou. I’m not proud of this, but I don’t want Lou to have these records if she plans to submit them to the LDS archives. The biggest reason I object is that if Lou does submit them, she will profoundly hurt living people for whom this is a major issue. Submission will also damage our shared history, possibly irreparably, and there are metaphysical implications.

Lou was never meaningfully exposed to our shared Quaker heritage. Before we moved to Arizona when she was five, we were members of young, family-oriented Meetings with First Day Schools for small children. These Meetings were like most Christian Sunday Schools for pre-school kids — songs, Bible stories and art projects. There aren’t many Quakers in Arizona, and the only Meeting my mother found thirty years ago was an elderly community of retirees who met as a house-meeting instead of in a Meetinghouse. Our former communities were programmed, with set speakings, hymns and discussions; our new one was the unprogrammed, traditional Quaker meeting of silent meditation until the Spirit moves someone to speak. At almost nine years old, I could handle an hour of First Day meditation in a little old couple’s living room. I liked the meditation, and not just as a contrast to my Saturday afternoon Catholic Youth/Folk Masses.

That Meeting, at that age, made Lou melt down. She’s mildly ADD, and even now, in her thirties, meditation drives her bonkers (her term). She prays while running, dancing or doing housework. That works for her, but by the time she was old enough to begin to understand Quaker theology, she was spending a lot of time with her LDS friends, including LDS services. Our Quaker mother would not force religious practice on anyone, so she let Lou go, and did her best to instill Quaker principles. Lou does not emotionally understand Quakers’ refusal of baptism by water and lacks emotional connections to the faith, practices and history. Further, Lou is the first person to say that she’s not adept at imagining multiple viewpoints. She’s a concrete thinker with a strongly materialist view of the world. I’m not surprised that the Mormon faith resonates with Lou — it’s a materialistic[2] faith. In LDS theology, there’s no real separation between the material world and the spiritual one.

Lou and I had a rocky relationship as children — we’re almost four years apart, I’m the oldest, we’re physically very different and had polar opposite temperaments from the beginning — but now that we’re adults and live a thousand miles apart, we have a pretty good relationship. We both grew up in a predominantly Mormon culture, so Lou knows that when she needs to blow off steam about her Church, she can call me. I understand Garmie Wedgie and Boob Sag[3] and the discomfort of wearing two layers from elbows to knees in the middle of a Midwest summer. We can, and do, riff on Funeral Potatoes and green Jell-o “salads”[4]. Lou has a snarky, sarcastic sense of humor and she spares nothing, but that doesn’t mean she doesn’t love and believe her chosen faith. More importantly, Lou knows that what she says to me won’t end up in the local gossip mill. (Every church, every group, has one.) I know what her spiritual requirements are, and how they affect her life.

I understand the social pressure that Lou is under as a convert. Even if Mormon communities didn’t have local pecking orders (which they do — they’re human) a Mormon whose N-great-grandparents crossed the Rockies in the 1850s has an assured lineage. It’s pretty likely that somebody in a fifth-gen Mormon’s ancestry has already done the genealogy work to fulfill the requirement and that those souls are already vicariously baptized. As a convert, Lou doesn’t have that simplicity, and the other side of her family is a dead end. Lou’s father’s grandparents were orphans. Two were New York City foundlings who were placed in something much closer to indentured servitude than adoption. The other two came from similar circumstances in Chicago and Indianapolis. As foundlings, they had no biological records, and given the circumstances, none of them claimed their “adoptive” families.

It’s a point of pride for Mormons to present their genealogies — and Lou admits, it’s mostly a temporal, not spiritual, pride. That doesn’t make it any less real. Lou does have records — another branch of the family is better documented, Methodist (thus, does not object to baptism) and long-since published, meaning those records are already in the LDS archives. (It’s a sound assumption that any published genealogy is in LDS archives. LDS genealogists have made a point of doing so for sixty years or more.)

I get that Lou feels that her immortal soul depends on her genealogy and that her place in her community is important to her. But I also know that Lou only needs four generations of records to fulfill her religious obligations. She has this already. In the case of the people still alive at the time of her conversion (her parents and most of her grandparents) she got their verbal permission to add their records and those of our recently-deceased relatives to the LDS Archives. [6] She has what she needs for her soul, and for her sons.

I also know that I have to tread very carefully with Lou and her faith. Lou can voice her frustrations to me, but she also feels that she must remain a member in good standing of her faith. Because the Mormon faith is both a faith of personal revelation and hierarchical authority, Lou is required to voice any doubts to her local leader. If I push too much on the theological inconsistencies (and like all faiths, the LDS faith has some), then I put Lou in the painful position of having to question her faith or not. If she doesn’t confess, that will make her feel fraudulent; if she does, then there’s a good chance she will be advised to stop speaking to her gentile family — and that’s all of us. We can threaten her belief, and for Mormons, that imperils not only Lou’s soul, but the souls of her sons.

Lou believes that we Gentiles (all non-Mormons are gentiles to Mormons) still have free will in the afterlife. She, and all Mormons, believe that we who are virtuous in this world and who either never heard the LDS message or were honestly misled (according to Lou, I fall into the latter category as a “virtuous pagan”) will gain a perfectly acceptable Heaven and that baptism only gives our souls the option of moving into the Mormon Celestial Kingdom where we will be forever joined with our families. (As a selling point — for me, anyway — this sounds more like a bug than a feature.) She believes that if a soul is baptized vicariously, it makes no difference if the soul doesn’t want it to make a difference.

But once I start thinking in terms of a soul and an afterlife, I have to follow that out, and Zenobia is my test-case. I assume that Zenobia’s Heaven is attained. Her eternity exists. By Quaker belief, she is in the presence of inward light, spirit and grace. She has found the divine and been led to Truth. She may be floating on a cloud wearing a halo and Birkenstocks, or wandering the Suffolk meadows or deep in the middle of some eternal game or nestled comfortably in a library chatting with Socrates. (Everything but the clunky sandals is in my conception of heaven.) Then some eternal bureaucrat appears, douses her with cold water and says, “We just got a memo. You’re now in the wrong Heaven. In the other one, you’ll be an eternal servant, the subject of some ascended god you’ve never heard of, who happens to be your many, many times great-grandson-in-law… Who in life was neither peaceful nor egalitarian nor simple. Will you go peacefully or DENY THE WILL OF GOD?”

Given the range of employment opportunities for 18th century East Anglian women — servant, servant, farm labor, servant, spinner, servant — I’m pretty sure Zenobia spent her teens and twenties in service. Returning to service is probably not what she had in mind for the afterlife. She was a Quaker who abjured rank, oaths, debt and war. She would have been plain-dressed, plain-spoken, convinced that women are the spiritual equals of men. She probably opposed slavery and welcomed black Quakers as her spiritual siblings. Her great-grandson-in-law would appall her, being that he’s military and invested in his rank; his faith denies spiritual equality to women. For Zenobia, this would be an expulsion from Heaven. If she stays, she is disobedient to the only authority she ever acknowledged as supreme and placing her will above that of God. If she goes, she’ll be deprived of her conception of Heaven and deny her own faith. Free will turns pretty Gumby-ish when talking about being in the presence of God. A faithful Quaker could not defy God’s will, because that’s what they lived by their lights. There’s a part of me that wonders if Lou’s vicarious baptism doesn’t condemn those souls to their version of Hell. I don’t know if Lou’s Celestial Kingdom is objectively better than Zenobia’s Inward Light of the Divine, but they’re such entirely different concepts that there’s no overlap.

I don’t literally believe this — I’m agnostic — but I do believe that, if there is an afterlife, my mortal mind is incapable of understanding it because my mortal mind is based in a very physical self. I don’t know that I have a soul, so if, after I’m dead, Lou feels the need for her own comfort and spiritual development to have me baptized by proxy, I don’t think I’m going to care. However, that’s my soul, or lack thereof. My partner is adamant that Lou does not know his vital statistics. He doesn’t think he has a soul either, but he considers vicarious baptism to be a vicious, callous, reprehensible denial of his personhood, even once he ceases to be. Lou knows this and my mother, grandmother and my other sister have been asked not to give Lou my partner’s information so that she’s not tempted to do back-channel recon. I know and my partner knows that Lou or one of my nephews (if they remain Mormon) will be able to get his records from the Social Security Death Index after he’s dead, but he wants his wishes respected while he’s alive.

We can’t ask the people in the Quaker family records what they want. Thus, when it comes to the Quaker family records, I feel responsible to honor their legacy and err on the side of respecting their choices in life. Lou feels a similar responsibility to their legacy, but in a completely different manner. Yes, these people are many years dead, but they felt so strongly about their beliefs that many of them moved to wilderness half-way around the planet so they could practice in peace. When Lou and I talked about my partner’s wishes, she argues from a Pascal’s Wager perspective, only more encompassing. Quakers don’t accept Pascal’s Wager; we consider it to be a violation of the Testimony of Integrity — denying the internal light of truth for momentary, mortal doubt. Lou and I also talked about it from the rationalist perspective — since my partner and I don’t think we have souls, what does it matter to us? Well, it matters for the same reason we have made wills. Our lives and our faiths are our decisions, to be respected and honored while we live and after we die. If we have souls, then we have the right to dispose of them as we will dispose of our fortunes, furniture and forms. A posthumous, vicarious baptism strips our volition from us. In a lot of things, I can be tolerant of my sister’s faith, but when her faith steps on other people’s volition, it’s no longer a case of tolerance.

I have the only record that Zenobia Faraday Harris ever existed. Her life, in the grand scale, meant very little to anyone except Zenobia, her parents and siblings (who are lost), her husband and children, her friends and fellow Quakers. History is full of people like her. She’s important because she was Quaker in a time when that was difficult, and she persevered. I don’t know who Zenobia was — whether she liked woolen or worsted, linen or cotton. Was she a tea drinker, or did she prefer coffee? Lark of the morning or night owl? I suspect she picked her daughter’s name (Ophelia) but did she or her husband name Zeno and Zebediah? Were their Z names in her honor? Was she dour or whimsical? Her children’s names sort of suggest whimsy, but I’ll never know. I do know she was brave and strong, because she crossed an ocean alone, in a little wooden ship, to a place that didn’t yet have glass manufacturing. I know that she left a wealthy, comfortable county for the pestilential swamp that was 1730s Philadelphia. I know she lived and died in the Society of Friends.

I know that if I give her to Lou, Zenobia will be baptized. Her name will be recorded in the LDS archives as a Mormon. I’m an independent historian. I know how friable human records are. I know how easily we lose documents. I know that they can vanish with a hard drive failure, or a house fire, or under an incendiary bomb. I know that even the early 19th century records that are my prime focus right now are fragmented and ephemeral. This means that I also know that in two centuries, all that may be left of Zenobia is the LDS record, and that will mean that the only non-physical fact of her existence will cease to be. She never denied her conscience. For me, if Lou vicariously baptizes Zenobia, that destroys the greater part of Zenobia’s existence — who she was. But for Lou, denying Zenobia baptism is denying Zenobia choice.

Quakers are not the only group in conflict with Mormons over this — Jewish groups have had rather terse conversations with the LDS leadership over the vicarious baptism of Holocaust victims, while Catholic and Anglican authorities have denied Mormon researchers access to archives. The Mormon response has been sketchy — sometimes defensive, sometimes defiant, sometimes conciliatory — but still the practice goes on.

In terms of my family, I don’t know how we’ll deal with this. It’s becoming a point of conflict because about a third of the family is Quaker. These records aren’t going away — I have this copy and Charity has willed the originals to me. I will probably see them placed in the William Penn University archives. I will be decrypting these documents, but beyond that, I can’t say. Part of me hopes that I can punt — that Lou’s other distractions and her other records will satisfy her while buying me time. I hope that she will accept and understand that other people feel as strongly as she does. Talking to her is going to be a long process.


[1] Names and some details changed to protect privacy.

[2] Materialistic in the sense that all things are composed of matter, and all phenomena are the result of material interactions. Not in the sense of pursuing wealth and luxury.

[3] Mormons wear sacred clothing next to their skin. The current female iteration resembles a thin, somewhat fitted tee-shirt and boxers/tap pants. Traditionally, Mormon women have worn bras and other foundation garments over these garments. This doesn’t work very well and everything tends to shift around.

[4] These are Mormon Culture foods, the equivalent of Mama’s cannoli or Granny’s schnitzel. They are always present at any group meal, but especially funeral potlucks. Nobody is quite sure where the green Jell-o thing came from, but the combination of cottage cheese or Cool-Whip, canned pineapple, marshmallows, coconut, tapioca or acini de pepe pasta and green Jell-o is considered a vegetable. (As with any unknown cultural artifact, it’s of ritual significance.) Funeral potatoes are a little more subject to cultural anthropology. They’re a quick-prep, inexpensive, pantry casserole suitable for sustaining hard labor. Shredded potatoes are mixed with sour cream and canned cream soup, topped with shredded cheese and either crushed potato chips or crackers, then baked. A 9″x13″ pan can be prepped in ten minutes and feeds eight as a main dish or two teenage boys as a light snack.

[6] Whether she explained the theological implications of her act is another matter, and one I haven’t gotten a clear answer upon. LDS policy is that, when requesting vicarious baptism for anyone who died within the last 95 years, the requestor must have the permission of the closest living relative. This policy is observed in the breech as much as in the practice, as shown by the recent vicarious baptisms of Stanley Anne Durham (President Obama’s late mother), 380,000 Jewish Holocaust victims, Mother Teresa, and Ruth (Mrs. Billy) Graham.