When I entered graduate school in something called the "Community/Clinical Psychology" program at the University of Maryland 36 years ago, I didn't know what I was getting into. I certainly hadn't been particularly drawn to community mental health—in fact, I wasn't entirely sure what it was. But, as a city boy from the Bronx, I felt at home going to a school near the roiling urban congestion of Washington, D.C., and, in the absence of better offers, I signed on.
Even as I suffered through my required classes in statistics and experimental design, I managed to pick up on an undercurrent of revolutionary fervor and a questioning of everything that represented traditional psychology. Much of that came from the visionary, often flinty, department chairman who seemed to harbor loftier ambitions for his students than we had for ourselves. Each Tuesday evening, he held an introductory seminar in his decidedly proletarian garden apartment, only slightly grander than my own grad school cubby hole. Each week, he relentlessly prodded us to debate psychology's social responsibility and pore over challenging books like Thomas Kuhn's The Structure of Scientific Revolutions as if they were sacred texts, and regularly punctuated his lectures with his favorite expression—"paradigm shift."
We soon absorbed the message that setting up a private little office somewhere to do individual therapy with well-heeled clients was about as socially relevant as retreating to a monastery to study medieval theology. We also imbibed a heady optimism about the power of family, school, and community interventions. Who knew what marvels might come from this radical new merger of clinical know-how, systems thinking, and social idealism. We felt we were part of a "movement," a merger of theory and activism that wasn't just an interesting experiment, but a blueprint for the future—a new, emerging truth about the inextricability of individual psychology and social systems that had repercussions as profound as Albert Einstein's theory of relativity.
Just in case you hadn't noticed, this is definitively not the world view driving the increasingly privatized mental healthcare system today. Public agencies, strapped for cash, dependent on shrinking grants, tangled in bureaucratic red tape, often just limp along, the demoralized stepchildren of the American mental healthcare establishment. Far from feeling fired up to change the world from within, most young therapists working in these agencies are there only long enough to obtain the clinical hours for their licensing requirements.
So is this issue—on the lost world of community mental health—just another exercise in middle-aged nostalgia? We think not. The fact is that life goes on in community mental health centers around the country, which, in addition to everything else they do, are the main source of hands-on training for most of the next generation of clinical practitioners. It's in this demanding arena that therapists are most regularly confronted with the broader realities of what our society is all about.
In the lead piece in this issue, "Rolling the Rock," David Dan reflects on his own 25-year saga in community mental health and the experience of others who've followed a similar path. Frankly acknowledging the struggles and disappointment that often come with life in the public sector, he writes, "I know that however impractical our career choice, however frustrating the work, and however unlikely it is that we'll achieve the kind of material success our society venerates, we feel truly alive and engaged only when we're in the thick of this impossible profession." Ultimately, he concedes, "those of us in community mental health don't so much choose the work—it chooses us."
Even today, for therapists like Dan and countless others, this work isn't a job, but a calling. It still has the power to remind them—and us—what psychotherapy at its best is all about.