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Personal Accounts: My Recovery: A Long, Winding Yellow Brick Road
Mark Glickman
Psychiatric Services 2012; doi: 10.1176/appi.ps.631201
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Mr. Glickman lives in San Diego (e-mail: marcin10@mac.com). He is on the Board of Directors for the International Center for Clubhouse Development, advocating through the development of clubhouses around the world for people living with severe mental illness. Jeffrey L. Geller, M.D., M.P.H., is editor of this column.

Copyright © American Psychiatric Association

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I want people to know that recovery from mental illness is not only possible but is happening all the time. Of course when I started my own journey on the rocky road of illness, I was sure that severe psychiatric illness was hopeless and that once it took hold, I would disappear forever down a rabbit hole of despair.

I was a happy child. Left to my own devices, I was in heaven. I could spend what seemed like hours staring at a reproduction of a Japanese painting, imagining ways in which it could come to life. Unlike other children who feared the dark or being alone, I sought the solitude of my father’s closet and would retreat there into my imagination.

At some point, though, the refuge I had always found inside myself began to fail. Around age 18 I started to feel a frightening alienation from myself and my own feelings. I experienced a gnawing sensation of emptiness that could be filled only briefly.

When I was 19, a crisis precipitated by a psychotic episode induced by experimentation with drugs resulted in an emergency hospitalization and my finally coming into treatment with a psychiatrist. I responded to the therapy and the medication I was given. I was able to complete college, make and keep new friends, and thrive again. The torrents of confusion, emptiness, and self-destructive behavior receded.

Unfortunately though, once out of the safe harbor of college, I floundered. I could get jobs but couldn’t keep them. I was obsessed with everything I ate. I began to doubt everything. If I dropped even the smallest, most harmless scrap of paper, I imagined that it could somehow harm someone else, and I would go out of my way to go back and find it. If I drove a car, I imagined I had hit a pedestrian. I became more focused on my food intake, my heart rate, my exercise, my medication—and why I shouldn’t take it. At times I would just cry—easily and very hard.

But more than that, the essential emptiness—that I was nothing and worthless—was engulfing me. Going off my medication made things exponentially worse. I was walking a tightrope where my thoughts and feelings were spiraling out of control and I had no safety net. My highwire act of staying up in the air despite my downward spiral came to an abrupt end. Within days of stopping my medication I went into a complete and total breakdown. I realized, with the total comprehension and shock of facing something life threatening, that I had gone over the edge and that my life had changed forever.

I was hospitalized. I had fallen very hard and very fast into a terrible state for which no medication or therapy really helped. After two months, I was discharged as “stabilized.” However, “stable” for me seemed to mean a walking state of disability. I could get from one place to another, but that was it. I was agitated, depressed, and unable to focus on anything at all productive, with raw feelings of anger and rage.

The discharge plan from the hospital was to go to Fountain House in New York City. Fountain House was founded as a self-help group in 1946 and then was expanded into a comprehensive program of psychiatric recovery in the mid-1950s by a social worker named John Beard. He pioneered transitional employment and fortified the culture of membership that was already established there.

By the time I arrived in 1973, Fountain House was already a large, thriving program of psychiatric recovery for people with severe mental illness. The hub of the program, called a clubhouse because of the emphasis on membership as opposed to patient-hood, was a beautiful five-story Georgian style building. Recovery in the clubhouse was based on voluntary participation in the work of the clubhouse and reintegration in the community through an ecosystem of opportunities, including transitional employment, housing, assistance with government benefits applications and management, and linkage to essential services such as psychiatric and medical care. The program focused on the talents and skills of the members instead of on their illness.

When I first arrived at Fountain House, however, all I could do was sit in a corner and watch the comings and goings. My symptoms were only somewhat less painful, and my ability to function was still severely impaired. I couldn’t really do more than simply travel back and forth to the clubhouse. The one thing that changed was that I began to make friends with some of the other members. Several, in particular, became the source of a new social network for me. I would stop by Fountain House to socialize with them, but I didn’t do much else there.

After some time had passed, I was approached by several staff members who asked me if I wanted to do a transitional employment placement at Macy’s Department Store. It was, as all transitional employment placements were, entry level, part-time, and temporary. My initial reaction was to say no, but I didn’t want to disappoint the staff workers, whom I liked, so I said yes. The job was humbling, but also the experience of just working again and getting paid for it felt good.

After Macy’s, I tried a few other jobs as well as living situations, which unfortunately didn’t work out. During this period, my symptoms gradually worsened again, and I slipped into another downward spiral, frighteningly similar to my first breakdown.

I was hospitalized again, and this time I was confronted by the reality that five years had gone by and I felt just as bad. By the age of about 30, I had seen my childhood friends move on with their lives and careers. Not feeling that I was making any progress in the hospital and that I was hopeless, I decided that suicide was the way to end my pain and despair. Although I was in a locked ward, I managed to slip out the front door of the hospital and proceed with my plan. I waited on the curb until a big city bus came along, and then I ran right in front of it. I instinctively covered my head with my arms. Nothing happened. I opened my eyes, and the bus was a few feet away, having managed to stop right in front of me. My suicidal urge was spent. I walked meekly back into the hospital and told the staff what I had done.

A change in medication was made.

From that moment on, I improved and continued to improve. I had hit bottom and bounced. Between the shock of my coming close to taking my life and the change of medication, a propitious cycle began. I began to see the clubhouse with new eyes. I began to see the work that took place there; even the most seemingly mundane things, like cleaning, cooking, or typing up newsletters, were part of a “gymnasium for function.” I made the link in my mind between physical rehabilitation and psychiatric rehabilitation, or recovery. I saw that, just as physical rehabilitation begins with light weights and simple, gentle stretching, so psychiatric rehabilitation and recovery begin with easy-to-accomplish tasks both in the clubhouse and then in the community, through paid jobs in transitional employment.

And just as physical rehabilitation has prosthetic devices for people who have lost limbs, psychiatric recovery offers invisible prosthetics. These include the many opportunities in the clubhouse, as well as those that extend deep into the larger community through employment, housing, and educational opportunities. Some of these supports are to be found in the synergy created by the respect and interdependence that develop between members and staff around accomplishing the work of the clubhouse.

Once I saw Fountain House through the lens of this understanding, everything changed exponentially for me. I realized that there was no limit to how much I could strengthen myself through assuming leadership in the clubhouse. By design, clubhouses keep the number of staff very limited, thus maximizing the need for the members to pitch in. So within that vacuum of leadership, I, like any other member, was free to grow and exert my growing confidence and ability.

After several successful clubhouse transitional employment jobs, I found my own job in retail and then retail management. After that, I leveraged my experience and confidence to go back to graduate school when I was 40 years old, to study broadcast journalism. I was able to work in the field for several years and finally left and made a documentary about the Fountain House program. I also eventually coauthored, with Mary Flannery, the first book about the clubhouse called Fountain House: Portraits of Lives Reclaimed From Mental Illness.

I see my development through the clubhouse paralleling that of Dorothy in The Wizard of Oz, where she and her companions have to find a heart, which is the ability to trust again; courage, the ability to try new things again; and a brain, the ability to reach one’s full potential.

So I have ultimately come to view the experience of having a severe mental illness as one which requires, in a certain sense, growing up all over again. I believe that what happened to me as a result of my breakdown resulted in a rolling back of my developmental clock. I had to regain my confidence, my courage, and my basic sense of competency. Having experienced this process and feeling in no way unique, I believe that clubhouses offer an ideal environment to fulfill one’s potential.

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