Working in community mental health, I have thought and re-thought and will continue to re-think the value of mental health care for people who struggle with poverty and oppression. My clients have many barriers to good housing and employment, including mental illness, poverty, and criminal histories. Even some of the most generous assistance programs are unwilling to work with certain criminal backgrounds, and I am left wondering what to do. I am one piece in a network of systems that at times can work beautifully well and at times utterly fail.

I went to a Jesuit high school that foregrounded social justice and service to others. These values feel important to my work and I fail at them often. I struggle to find some ground for what I believe is the best way to help others, and then Spirit comes along with a new confrontation that undoes my certitude and challenges my beliefs.

I value mental health work and psychotherapy. I think it is transformative. I believe in the power of the human spirit to transform our pain into gold, to do more than survive, to develop lives of meaning and purpose regardless of our circumstances. I also believe that we are social beings affected by our environments and cultures. Some of us might be hardier or more privileged than others, but it is hard to support a life of dignity and self-respect in a culture of constant violation, degradation, and trauma.

We all live in this culture and feel its effects in some way. Shame is crippling. Whether conscious or not, we are suffused with constant uncertainty of hustling for material success and the awareness that we can lose it overnight even if we do everything “right.” The challenge of doing mental health is meeting someone with physical needs and hearing the emotional needs behind it. Which do I address?

Clients come to a healer expecting to be healed. There is a certain childlike quality, wanting the good parent to come make everything better. Every healing profession has an array of tools that can aid, but the discouraging secret is that you have to take part. The doctor can prescribe medicine and exercise and you’ve got to follow her recommendations and let her know how you’re doing if you want to change. You can go to detox, but you need to commit to sobriety. The counselor can help you sit with your depression but you’ve got to want to change. You can ask for help with housing, but you’ve got to put in some work. The healer, too, needs to show up and risk being changed. Healing moves in both directions. So does harm.

I think both the healer and the client face the fear that we are not enough for the task. We sense the depth of need and the expanse of the wound. There’s a temptation to resent others for not having the same amount of pain, the same amount of struggle, and to feel a sense of entitlement to help. Because my life was not the way I wanted, I should get special help. But the CEO with depression who cannot find the drive to get out of bed is no more or less self-actualized than a person with depression who is living in an emergency shelter and cannot find the drive to call and find housing options, although the CEO has more privilege and access to resources. Each experiences their pain as the most important, searing, unbearable pain in the world. This is the basis of compassion: recognizing that your pain is as real and important to you as mine is to me. This is the basis of self-responsibility: realizing that we all have burdens and the greatest service we can offer to others is to learn to carry ours with grace. This is the basis of mutual respect: realizing that each of us is real, each of us is doing the best we can with life as we understand it, even when our behaviors seem odd or disruptive, and we share a need for connection and support.

When faced with a problem, it’s easy to become fixated on finding an external solution and ignore the inner causes of the problem. We’ll keep re-creating the problem until we finally see what within us needs to keep having it, what we are failing to learn and integrate. That’s one way of seeing things. Another way is seeing that our culture unfairly distributes privilege and oppression, and some of us are given easier lives than we’ve earned while others have to work twice as hard to get half as far. Some of us get frisked, arrested, and brutalized by the police for doing the same crimes as others who get overlooked or special favor, and the only differences are race or where one lives.

Both of these views have implications for healing and I do not know where the balance is. I know that I’m a White male and that shapes the way I view the world. I know that I favor introspective soul work and that’s not what my clients always need. I know that there’s a lot about surviving and thriving in this world that my clients understand in a way that I do not and never will. I seek a way to respect my training, judgment, and intuition while listening humbly to what the person in front of me needs.