Photo: Harbor House - room dedicated to meditation and mindfulness practice.
“There are no coincidences in life,” a fact repeatedly reinforced on the journey I’ve undertaken. Continuing the mission of bringing ACE awareness to others, I recently found myself interviewing Josephine Ruiz-Carpenter, a colleague I worked with when I first graduated from college.
Starting out as a caseworker, Josephine has worked her way up. From job training, job coaching, pre-vocational programming, housing -- she’s done it all, and is now director of Harbor House, a partial hospitalization behavioral health service center in Paterson, N.J.. Harbor House offers services such as outpatient or partial hospitalization care for people 18 and older who are dealing with serious mental illness, mental health and substance abuse disorders, and those struggling with PTSD.
“This is going to sound schmaltzy, but this work is what drives me as a person; it's my goal, it’s my vocation,” Josephine declared. She recalled that when she was in training as a rehab counselor she went to a partial hospital to do her internship and really disliked it terribly because it was very strict, regimented, very much a silo. “If this is what it’s going to be like, I thought, it’s not for me,” she said. After the partial hospital internship experience she was getting ready to pack her bags, take her masters in education, and as she says, “take my act on the road.”
But this was not to be, due to the persistence and insistence of one of her professors who suggested that she go meet with a man who was running an interesting program, Bob Harvey, who was then director of Harbor House. A week went by and she had not followed his suggestion. Week two comes along and again he asks if she’s met with the director to which she answers, “No.” So he says, “If you don’t follow through and meet with him, I’m going to give you an incomplete!” She said, “You can’t do that,” and he replied, “You want to watch me?”
“I knew there must be something making him so insistent, so I ask him why he’s being so adamant," Josephine explained. “I know this organization. I know you. I know you have what is needed to work there,” he told her. Josephine recalled that “he used to tell me that I was earthy, called me his diamond in the rough.” Josephine and I laugh.
Needless to say, Josephine went to Harbor House. “I walked in and saw maybe 25 clients, saw the small staff really getting down and dirty. They were cooking together, cleaning together. They worked on the apartments and ran the thrift shop together. I witnessed the camaraderie, and the connection that I knew was essential. I observed it and I said, 'This is what I wan to do.' I knew that I could connect with them because I know that what drives me are the relationships that I have. I knew that the people being served were no different than myself! I did the interview and when I left I didn’t even know what the job paid, but when I got the call I didn’t think twice and took the job,” she said. That was back in 1976 and she’s never left.
“I remember having this conversation with one of the Sisters of Charity who run this hospital. We went out to dinner, had a few glasses of wine and we’re talking. She said to me, 'Do you think that your being here is pure coincidence?' She didn’t have to say anymore. I grew up here, came here when I was 24, met my husband here, got married here, had my two children here, and they went to daycare across the street. This place is very much a part of who I am! For me, it was my destiny to come here.”
The funding folks and the programming people do not necessarily see the importance of this kind of story. They go to Harbor House and they’re impressed by the external: The place is clean, people from all walks of life, cultures and religions are getting along, they rarely have violent or disturbing incidents. “They don’t see the resilience of the people here, the love in their hearts. That love is what gets to me,” said Josephine.
"I have clients here who have absolutely nothing, have been through hell and back and yet when something happens to someone else they have that extra part of themselves to give, that part of them that is concerned with others' well-being. They are constantly concerned with me as a person -- not a staff worker but me, Josephine. I’m talking about myself personally. My mother passed away no more than two months ago and they were phenomenal. I was fine with all my family, my friends, the wake, the funeral and all. That is till I came in here and people started to give me their sympathies. I was 'Oh you're killing me guys!' I walked in and they gave me so much love I couldn’t hold it together. It amazes me, just amazes me!
"We are told you are not supposed to take any gifts from our clients. They come and bring you these little things that mean the world to them. For me to say to them, “I can’t take that,” because of rules and regulations? I mean that’s such an insult to people, to their humanity! I come from a Hispanic culture. You don’t do that to people. They’re great, really great! They get up every morning and fight the fight, and the love that they are capable of is so overwhelming, so overwhelming."
Josephine confided, “As a woman watching the women of my culture put up with so much stuff -- domestic violence, abuse, not being given their due, always in the shadows, having to blend into the woodwork. Women like my mother. You see their struggle and what’s more important is you witness their selflessness! When you witness that unconditional love from another human being, it can make you feel small. For myself, my mother was a very bright woman but my father never gave her the credit and validation. The way that it impacted me was that the more he didn’t give me recognition for what I did and accomplished, the harder I worked. More to show him that I could it, despite what he said. I still did not get much recognition but it sure felt good to do it because you knew you could do it.
"Harbor House was part of the de-institutionalization thrust in the late 70s, early 80s. We were trying to teach people how to survive here in the community, give them a place to attend during the day and help them get back on track, it was a place of hope where they could go back to school or work,” Josephine explained. "When I was at Harbor House in the early 80s what we modeled was copied from Fountain House in New York. A model that has been copied and used in many places throughout the world. We basically provided basic life needs according to Maslow’s principles: a place to go, a place to live, and a place to work. Actually our brochures were set up like that at that time.”
She went on to tell me that in the 38 years that she’s been at Harbor House, at every assessment/interview she’s ever done, either the person has said, “I want to go to work” or when asked "What do you want to do?", their response has been, "I want to go to work!" Josephine feels that the society we live in defines you by the job you have. “What you do is very important in regards to the social structure. When you ask a person with mental health issues, 'What do you do?' and they don’t have a response, but your response is 'You do nothing?' it’s hard to live with that. The reality is that many don’t work because they are suffering from this illness, their lives are being constantly interrupted, they don’t get to finish school, achieve success on the job….the things you and I do."
There are many problems with the current system, but one of the problems that Josephine identified is that most agencies have been set up to deal with the specific issues that an individual is dealing with. Added to that, many of them exist in their own individual silos. In the case of Harbor House, the service provided focuses on individuals with severe persistent mental illness. “But the reality is that we focus on their specific illness and along with that comes a lot of other issues as well, which the person brings. They are no different than any of us! They bring their person, again no different than you and I. They bring all the issues that they’ve had in growing up, all the issues one has living a life."
Harbor House does to an extent, at least from their philosophy, deal with those issues. “Although we are not able to commit the time and the level of focus that we would like to because that’s not what we get paid for,” said Josephine. But they do have certain treatments, if you want to call them that, that they offer their clients that are not part and parcel of what the state funds and pays them for. “So once we meet the needs or requirements of what we are funded to provide, we then in addition provide individuals with additional factors because we are invested in treating the whole person. We are not disconnected from the neck down.”
“For example, we started to use meditation as a form of treatment or coping mechanism, a tool, if you will, that individuals can use to help themselves so that when they are no longer here and we are no longer available to them and able to provide them with support or guidance, they can at least use this tool that we teach them so that they can have the ability step back when they are struggling and have something that can help them center themselves again,” said Josephine. They’ve dedicated one room that they call their meditation room to help them practice mindfulness, a concept that really anyone can benefit from no matter who you are, or what your position or station in life is. “The room is a place where people can go when they want to go on their own and in which we hold meditation groups throughout the week. We also have a place of worship/prayer - not particular to any religion but where someone can sit and pray to whoever they pray to for solace and guidance and support -- little things that are beyond the vocational training programs that we offer.”
She shared with me that there are many people who come to Harbor House who, for lack of a better term, are broken individuals and are severely, persistently mentally ill. Along with the mental illness they have secondary issues such as substance abuse. There is also a deaf community, and Harbor House also serves the monolingual Hispanic population. “We attend to all of them using best-practice modalities that are used here, but we also understand that the person we are treating is a whole person and that’s the problem," she said. "All types of things come up when they are in treatment here and we are not given the time or the funding to focus on them, so we basically are made to focus on what we are funded to do.
“I’ve always concerned myself with the fact that there are many aspects to an individual. One must learn about the person, learn their stories, let them tell you their stories. We all have our individual stories, they are very unique, like our fingerprints. Our stories are very important, and given the opportunity, individuals are able and willing to share them. And when you hear the story, one can’t help to be amazed at how functional and resourceful individuals are prior to their having to go to the hospital.”
Josephine went on to speak about the fact that medication has side effects that bring on metabolic issues: “The journals tell us that an individual who takes psychotropic medications on average shortens their life span by 25 years, so in addition to dealing with the mental illness, you are dealing with the secondary issues of the medication such as metabolic issues, cardiac issues, and endocrinology issues like diabetes. Again, we don’t look at it as a whole -- we look at it in a segmented way. We treat the symptom but not the whole person. We need to understand that mental illness is not the person. The person happens to have mental illness, but it’s not who they are!"
When she looks at the history of the people she has encountered and listened to their childhood stories, she has seen a pattern, things that have compounded the problem--people who have grown up with domestic violence, alcoholism, intercultural violence, sexual abuse. “These experiences compound the problem and stop the person from being able to develop themselves. They get stymied. Many yearn to go back to a point in their life when they felt they where doing okay -- a particular school, work, a relationship. That’s when they felt they were normal, and when you analyze it it’s probably the worst thing they could do because part of their problem stems from what was going on in their life at that time, and for many of them, developed into the issues that they suffer from today. For example, they might have been abused at home or at school."
Yes, the holistic approach is the best, most effective approach, Josephine believes, but it costs a lot of money. But when you look at the results, it’s well worth the money. The people making the policies – whether it be county, state, or federal – need to look at these tools, these life skills that we all need and can benefit from, and see them as essential. Meditation, nutrition, and exercise -- things we are finding can be incredibly important for individual health and well-being need to be supported through adequate funding.
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