Loren Swartzendruber '76, MDiv '79, DMin

Uncle William did not look like a hero to me when I was a child. As I got older, I came to realize that this Iowa farmer had been one of hundreds of young men who served the nation during World War II by tending to people who previously had been treated as beneath “the least of these.” William H. Nisly was a conscientious objector in Civilian Public Service from Oct. 3, 1942 to March 1, 1946. Much of that time, he was an attendant in the Kalamazoo State Psychiatric Hospital in Michigan.

When Uncle William returned to Iowa after the war, he talked about the deplorable conditions he had seen in Kalamazoo. He spoke about how he and his fellow conscientious objectors had tried to improve these conditions with simple kindness, despite severe staff and material shortages. Today, the importance of “kindness” in dealing with mental illness is disputed by no one. But this wasn’t the case 70 years ago, as the nation discovered when the conscientious objectors helped draw attention to widespread mistreatment of mental health patients.

At least 29 alumni – counting those who came to EMU either before or after the war – served in one of the 22 mental health facilities staffed by Mennonite Central Committee. It is no accident that in the late 1940s, the Mennonite church began to take steps to establish model programs for mental health care. At one of these programs, Prairie View Behavioral Health Center in Newton, Kansas, my wife Pat served as vice president from 1994 to 2003, after having begun her career as a psychiatric nurse at the University of Iowa Psychiatric Hospital.

Many of EMU’s graduates have interned or worked in one of these model programs, including one of my children, Angela Hackman, a graduate of Hesston College in 2001, EMU in 2003, and finally the University of Pennsylvania, where she earned an MSW. Angela is employed at the Penn Foundation in Sellersville, 40 miles north of Philadelphia.

Here at EMU we are continuing the tradition of concern for mental health through our psychology department, applied social sciences department, and master’s in counseling program. We aim to remain on the forefront of this field, as demonstrated by an unprecedented conference at EMU in the spring of 2011 on the theory of “Attachment.” More than 1,000 people came to hear distinguished speakers discuss current neurological and psychological research showing that healthy attachments are crucial for humans to survive and flourish. Christians, of course, have been saying this for millennia, but it is gratifying to see our beliefs in love and community confirmed by science.

I hope you will read these pages with appreciation for the footsteps in which we are walking as we reflect on the dramatic overhaul of mental health care since 1945 and continue to strive for improvement.

Loren Swartzendruber
President

Conscientious objectors (in white) attend to patients in the mental unit of Cleveland State Hospital during World War II. With 2,800 patients in 1945, the hospital was 600 over its capacity. “The hospital had a poor reputation with respect to patient care,” according to The Civilian Public Service Story at http://civilianpublicservice.org, “Workers had to fight cockroaches and filth in overcrowded wards, and (non-CPS) attendants controlled patients by shouting and beatings. The ‘incontinent and violent’ wards lacked sufficient supplies or activities for patients and experienced reports of injuries to patients and employees.”

The first night at Western State Hospital in Staunton, Virginia, was horribly memorable. Emory Layman, assigned by Mennonite Central Committee (MCC) to work as an attendant at the mental hospital during World War II, was shown to a bed in a cramped office, just off the noisy ward full of patients, many of them shackled to their beds. He later wrote:

I shall never forget that first night.… Soon after I was settled in bed the rats began to stir, one running over my pillow. I was wondering whether to go to sleep and not mind the rats or to get up, when I felt a few bites and then it dawned on me that there were bedbugs at hand .… The night attendant didn’t know what to do so I sat up with him until … two or three o’clock in the morning .… [Then] I finally got a little sleep.

Layman was one of about 12,000 men who performed alternative service as conscientious objectors (COs) during the war through the Civilian Public Service. Men from dozens of religious groups were COs, but the Mennonite contingent with 4,665 COs represented by far the largest church cluster, with the Church of the Brethren being the second-largest group with 1,353 COs, and the Society of Friends (Quakers) the third-largest with 951 COs.

Approximately 3,000 of these COs were assigned to some 40 mental health institutions across the country, filling a desperate need for staff after conscription for soldiers and budget cuts necessitated by the war. As reflected in their diaries, letters and later recollections, many of these young men were appalled at the inhumane conditions they encountered.

Russell Schertz, assigned by MCC to work in Mt. Pleasant Mental Hospital in Iowa, recalled the conditions 50 years later:

As I encountered the deplorable conditions on the mental health wards – unsanitary filth, patients tied to chairs, in straight jackets, locked in dingy rooms, and sometimes beaten by previous attendants – I became aware that this was an issue of justice.

At another facility staffed by MCC personnel, the Hudson River State Hospital in Poughkeepsie, New York, Willard Linscheid reported that he was assigned to a ward of 110 to 120 patients, with just one male nurse and one other attendant on duty.

Because of the large number of incontinent and destructive patients, clothing was destroyed and soiled – much of the time the disturbed patients in the small day room were entirely naked. Because of the wartime shortages of sheets and blankets the majority of patients had only one sheet or blanket on their beds most of the time. If possible, the disturbed and incontinent patients were also given a blanket or sheet, but much of the time they slept naked and uncovered on the hard canvas mattresses.

Charlie Lord, a Quaker CO at a Philadelphia mental hospital known as Byberry, secretly took a series of pictures that ran in Life Magazine on May 6, 1946, as part of an exposé of the horrific state of the country’s mental hospitals. Lord’s photos showed groups of naked men, huddled together on the bare concrete floors of otherwise empty, cell-like rooms, frighteningly evocative of scenes from European concentration camps still fresh in the minds of the American public.

Working in Mental facilities

How did thousands of conscientious objectors end up working in mental health institutions in World War II? The answer starts centuries earlier.

For generations, members of the traditional “peace churches” – the Anabaptists, including the Mennonites, Amish and members of the Church of the Brethren, along with the Quakers – have taken the position that Jesus opposed killing other humans or even treating them violently. Period. For many, this position extends to not supporting organizational efforts to kill people, as represented by military efforts.

Before the twentieth century, religiously inspired non-combatants in North America and Europe typically were expected to provide substitutes for their lack of military service, pay stiff fines, or do prison time if they resisted conscription. The consequences for refusing to fight were sometimes severe. In the region of Virginia where EMU is now located, Mennonites were hunted down for their refusal to join the Confederate Army in the 1860s.

During the last year of the war, when the Confederacy was sorely in need of men. . . attempts were made to impress young Mennonites into the army, with the result that many went into hiding in the mountains [of western Virginia], some of them being hunted by army scouts who had orders to shoot them at sight.

During World War I, men who refused military service on religious grounds began to be called “conscientious objectors” or “COs.” In addition to men in the peace churches, there have been COs in smaller numbers from dozens of faith traditions, including Catholic, Methodist, Baptist, Presbyterian, Lutheran, and Jewish. Jehovah’s Witnesses also consistently refuse to do military service, though their reasons typically are different from those of most COs.

In the WWI era, 138 Mennonites were court-martialed for refusing to comply with conscription and were sent to prison. Nearly 2,000 other Mennonite men, however, were able to do alternative service in camp-type settings, a role for COs negotiated by the American Friends Service Committee (a Quaker organization). Yet most COs were not given productive roles in the WWI-era camps. More often they were subject to degradation.

Men were forced to stand at attention, sometimes with outstretched arms for hours and days at a time on the sunny or cold side of their barracks, exposed to the inclemencies of the weather as well as to the jeers and taunts of their fellows until they could stand no longer; chased across the fields at top speed until they fell down exhausted, followed by their guards on their motorcycles; occasionally tortured by mock trials, in which the victim was left under the impression to the very last that unless he submitted to the regulations the penalty would be death. Every conceivable device – ridicule, torture, offer of promotion and other tempting inducements were resorted to in order to get them to give up their convictions; but with only few exceptions the religious objectors refused to compromise with their consciences.

The counter-productive treatment of CO’s during WWI motivated leaders of the peace churches to lay the groundwork for better alternative-service possibilities during future wars. The Selective Service Act of 1940 provided for COs to do work of “national importance” under civilian direction.

In World War II, this work took the form of largely unpaid labor  – on farms and on government-owned land, fighting fires, being guinea pigs in medical experiments, and working in understaffed hospitals, particularly mental institutions. Despite the conditions under which they labored – and their extraordinary length of service (the last COs were released in March 1947) – COs were treated scornfully in wider society. They were called cowards and worse epithets, hung in effigy, refused service in public places, and subject to venomous campaigns by veteran’s groups.

To ensure hardship, the COs were required to serve at least 100 miles away from their homes. Most of the Mennonites did their alternative service under MCC’s umbrella – an arrangement set up with the federal government. MCC assigned them to federally approved work situations and provided the only compensation they received, which was no more than $15 monthly for essentials (shoe polish, shaving cream, toothpaste, and such).

In tacit acknowledgement of the scorn heaped on COs, John F. Kennedy said:

War will exist until that distant day when the conscientious objector enjoys the same reputation and prestige that the warrior does today.

Seeking Improvements

Though it never attained the infamy of Pennsylvania’s Byberry, Virginia’s Western State Hospital in Staunton, Virginia, less than 30 miles south of EMU, had similarly disturbing conditions. It was one of the first institutions staffed by COs. Charged with assisting 2,000 patients, the first 19 men sent by MCC worked an average of 76 hours per week for their first year in this hospital, receiving an allowance of $2.50 per month. One CO did not have a single free day in seven months of work. Eventually a total of 110 COs worked in this institution between 1942 and 1946.

Among the EMU alumni in the CPS unit at Western State Hospital was Clarence Kreider ’40, who kept a journal detailing the inadequate meals served to hard-laboring staffers (e.g. on January 3, 1943, beans and prunes for lunch, and red meat and sour pears for dinner; the next day,  potatoes and apples for lunch, and meat and more apples for dinner).

When a Staunton Episcopal priest, W. Carroll Brooke, learned about the appalling conditions for both patients and employees at Western State, he gathered testimony from the COs in Civilian Public Service (CPS). Together they urged officials at the state level to replace the hospital’s superintendent and increase funding for mental hospitals. Trained cooks were among the improvements to emerge from the efforts of Brooke and the leaders of CO units in other Virginia hospitals.

In 1945 Harry L. Kraus Sr. asked to be assigned as a CO to Western State, in part to be closer to his future wife, Mildred Brunk, living in Harrisonburg. Caring for the patients at Western motivated Kraus to overcome great odds to become a physician after the war. He and Mildred raised chickens to pay the fees for his undergraduate studies (he started at EMC but finished at Bridgewater in 1951, for reasons of class scheduling).

Across the nation, the COs found that mental hospital conditions “were deplorable. . . . They [non-CO staffers] treated patients like animals,” said retired EMU administrator Paul T. Guengerich, who served in the CPS from July 21, 1942 to March 9, 1946. In a 2006 interview with EMU undergraduates, Guengerich said that patients “were abused, and our COs that worked in hospitals did all they could to bring some change to that. They felt that these patients deserved being treated like human beings.”

With as many as 300 patients for each attendant, however, there were times that the COs felt uncontrollably frustrated, showing “fits of temper” and employing “unnecessarily rough language and rough handling of patients,” admitted Linscheid. Yet the patients and their families expressed gratitude to the CPS-assigned workers, telling the COs they were doing a much better job than previous staffers.

Referring to the Hudson River Hospital, Willard Linscheid said in the short term:

Our efforts were concentrated on giving better and kinder treatment to the patients and to keep the ward as clean as possible under the circumstances…. We all chafed under this necessity of giving only custodial care and we were all keenly aware of the improvements that could be made with more attendant help, more supplies and better facilities.

In the longer term, Linscheid said:

We were all fired with a desire to expose mental hospital conditions to the general public in the hope that such an exposé would lead to action toward improvement of such institutions. Certainly to work for any length of time on such a ward a person must either agitate for betterment or sear his conscience entirely to the ills of humanity.

The COs struggled with how to handle patients’ violent outbursts, especially given the shortage of staff. Henry E. Nachtigal, a 26-year-old General Conference Mennonite from Kansas, died on September 1, 1945, after he received a head injury from a patient at Western State Hospital in Staunton.

Patients in a New Jersey hospital killed an abusive attendant – who was not a CO – with his own billy club. The next night, a Mennonite CO named James Kuhns was told to enter that same ward and take charge. Kuhns went armed only with the keys to open the door to the outside. “I could walk out anytime. They could have taken my keys and walked out too.” But the patients didn’t; they liked Kuhns better than the attendant they had killed. Kuhns worked on that ward for several months and developed relationships that made it “an enjoyable experience.” He especially liked tending long-time residents who had chronic illnesses, such as tuberculosis.

By the end of the war, more than 1,500 CPS men had worked in Mennonite-run units at mental hospitals in 14 states, including at least 29 who are EMU alumni.

Women’s CPS Service

In support of the conscientious objector cause, around 300 women volunteered to work with CPS units at mental hospitals during the war.

Edna Ramseyer, a dynamic woman who taught home economics at two Mennonite colleges, Bluffton and Goshen, initiated the “C.O. Girls” with these goals: relieving human need, strengthening the witness of the Christian peace movement, and supporting the stand taken by male COs.

“C.O. Girl” Bernice Meyer Miller explained: “I was motivated to show the world that COs were not slackers, but were willing to serve in positive ways.”

Ruth Miller Willems, a nurse at the MCC-staffed Rhode Island State Hospital, said:

Frequently I was assigned to care for the most disturbed patients. I was often frightened but tried not to display my emotions for the sake of the employees and patients. I tried to win their respect by showing love.

Some of these volunteers were the wives of COs, but many were college students who used their summer breaks to work in mental hospitals.

At the Cleveland State Hospital in Ohio, CPS men and women under the American Friends Service Committee jointly filed reports on how abuse and neglect had led to the deaths of patients. The hospital administration retaliated. Deteriorating work conditions caused CPS workers to be withdrawn from that hospital in November 1943. A year and a half later, at the request of a new superintendent, CPS workers returned under the care of MCC. In 1945, 19 women recruited from Mennonite colleges came and gave “unusually good care” to patients in the women’s infirmary at Cleveland; the following summer, the program was repeated with 22 college women.

In one hospital the C.O. Girls developed these guidelines for themselves:

• Speak a greeting to anyone, everyone on the hospital campus, in the corridors, on the wards, in the cafeteria;
• Be willing to do any task regardless of how menial or filthy;
• Be willing to mingle and eat with others in the dining room;
• Discuss first with your ward attendants any concerns you may have about unsatisfactory conditions; and
• Be at anytime ready to give witness to what you believe.

Eleanor Roosevelt’s Support

In early 1943, Eleanor Roosevelt interviewed a number of COs at an MCC-staffed hospital in Marlboro, New Jersey.  In her “My Day” column on January 16, 1943, Roosevelt described these COs in positive terms:

We met here with some of the group of Mennonites, who are conscientious objectors, and who have volunteered to serve in hospitals for mental cases. They are a very fine group of young men and bring a spiritual quality to their work because of their religion. In many ways, this is probably raising the standard of care given the patients.

On July 9, 1945, at the invitation of Edna Ramseyer, Eleanor Roosevelt and her secretary visited the MCC-sponsored mental health unit of the Hudson River State Hospital in Poughkeepsie, New York. Two days later in “My Day,” Roosevelt referred to meeting a group of workers belonging to the Mennonite church and elaborated:

The superintendent told me that they had undoubtedly raised the standards for the care of patients, and that they had been of tremendous help in disclosing certain practices which existed there and about which he never before could get any real evidence. He said if they could stay longer they would probably improve the standards even more.

At war’s End

Reflecting on his four CPS years that concluded at the Hudson River institution, Samuel Yoder wrote:

In late December 1945 I was discharged. I was going home. The overnight trip gave me time to reflect on my four years. I had served in five units from coast to coast. I had switched cultures and church affiliation. I had met wonderful persons in CPS, believers from Mennonite General Conference, Mennonite Brethren, Brethren in Christ and a large number from the Mennonite Church of which I am now a part.

I had matured in my Christian faith and was stronger and more sure about my peace position. My experience in three mental hospitals in a small way was a part of the fabric that laid the foundation for our own Mennonite Mental Health program . . .

. . . I arrived in Goshen via New York Central on a Saturday morning and as I stepped off the train there was no band to play, no parade to ride in, not even yellow ribbons tied around the old maple tree.
But there was the horse and buggy – my folks were there to meet me and welcome me home.

Modeling a Better Way

By 1947, as a national reform movement was taking off in response to the Life exposé and other stories told by the COs, MCC had convened a committee to study the possibility of establishing church-sponsored institutions offering mental healthcare services as a humane alternative to the state institutions.

“These people felt there had to be a better way,” said LaVern Yutzy ’70, a therapist who served nearly 20 years as CEO of Philhaven, one of the Mennonite mental healthcare facilities that was established in the aftermath of the CPS experience during WWII. “So they said, ‘Let’s see what we can do about this.’”

In 1949, Brook Lane Farm in Leitersburg, Maryland, was the first Mennonite mental healthcare facility to open its doors, with beds for short-term treatment of 23 patients with acute mental illnesses. While some in the church thought that Brook Lane and other similar institutions should largely rely on compassionate treatment in a “home-like atmosphere,” other leaders in the reform movement cautioned that professional medical staff was a necessity. Eventually, the latter group prevailed. When Brook Lane opened, a psychiatrist from Baltimore began making twice-weekly visits to see patients there.

Within a decade, four other church-run facilities to treat mental illness opened across the country. Kings View opened in 1951 in Reedley, California, followed by Philhaven, established in 1952 in Mount Gretna, Pennsylvania. In 1954, Prairie View opened in Newton, Kansas, while the Penn Foundation began seeing its first patients in Souderton, Pennsylvania, in 1956 (it has since relocated to nearby Sellersville).

During the 1960s, three more Mennonite-affiliated institutions joined the group: Oaklawn in Elkhart, Indiana (1963); Kern View in Bakersfield, California (opened in 1966, but now closed) and Eden, in Winkler, Manitoba (1967).

Grant M. Stoltzfus ’38 was an EMU alumnus who played a role in the post-war establishment of these Mennonite institutions. During his three years of service with the CPS, Stoltzfus had worked for a time at the notorious Byberry hospital in Philadelphia.

In 1945, Stoltzfus became the director of a unit at the Woodbine Colony for the Feeble Minded in Woodbine, New Jersey, where more than 20 men worked with hundreds of children with intellectual disabilities.

His final CPS assignment was writing educational pamphlets and researching how churches could run mental healthcare facilities for the National Mental Health Foundation, a reform-focused organization sparked by the CPS experience.

Stoltzfus eventually served as a professor of sociology at EMU from 1957 until his death in 1974. Former students recall his unflagging interest in mental health care and the way he influenced them to work in the field.
Another alumnus who played a prominent role in the early days of Mennonite-led reform in mental healthcare was Norman Loux ’42, M.D. He left a prestigious job at a psychiatric hospital in Rhode Island to serve as the founding  medical director of the Penn Foundation. Loux remained in that position from 1955 to 1980.

Community-Oriented Care

Belying their small size, the Mennonite-sponsored mental health facilities played important roles in sparking wider initiatives. Originally founded to provide the mentally ill with humane and compassionate alternatives to state institutions, their institutional missions soon grew to encompass outpatient and day treatment programs.
Another innovative approach taken by many of these organizations was a therapeutic focus on treatment within the larger community, resulting in broader outreach efforts and increased involvement of patients’ families.

Retired EMU sociology Professor

Titus Bender ’57, who earned a doctorate in social work at Tulane and who spent decades involved with the lives of marginalized people, published an article in 2011 about the impact of Mennonites on the larger mental health movement. In it, Titus spoke about a shift from volunteers to professionals in the 1960s:

Volunteers as a significant segment of hospital staffs gradually gave way to increased emphasis on clinically trained staff. This created some consternation among a segment of the Mennonite constituency who had envisioned a “homelike atmosphere” and lay involvement as crucial ingredients of a Mennonite-sponsored mental health program. Increasingly, the encouragement from the center was for Mennonites interested in mental health care to get professional training. Volunteers continue to play a vital role in assisting those with emotional stress to become integrated into the community.

The efforts at Mennonite institutions attracted national attention. Prairie View received a gold medal from the American Psychiatric Association (APA) in 1968 for its community mental health services, while Kings View received the same honor in 1971 for its contract model with local government to provide mental healthcare. In the 1960s, Prairie View and Oaklawn were cited as examples of innovative providers of mental healthcare in publications by both the APA and the federal department of Health, Education and Welfare. And in 1964, a profile of the Penn Foundation’s treatment programs was the lead chapter in a book of case studies compiled by the APA.

“[These institutions] can take pride in their accomplishments on a national scale,” wrote Lucy Ozarin, a longtime physician with the National Institute of Mental Health, in the early 1980s. “[They have] served as a. . . model for a nation to follow in providing psychiatric care where and when people need such help.”

Mennonite College Role

While the church-founded mental health  institutions were becoming established and recognized, EMU was taking steps to prepare students for entering the mental healthcare field.

In 1961, Laban Peachey ’52, who had been a 19-year-old CO at Rhode Island State Hospital in 1946, became the founding chair of EMU’s department of psychology. “I was definitely influenced to go into psychology by working at the hospital,” Peachey told Crossroads in February 2012. “But I didn’t want to work with ill people; I wanted to keep people from getting ill.”

Beginning with graduate courses in psychology at Boston University and the University of Virginia, Peachey worked his way toward a doctorate in counseling psychology from George Washington University in 1963. In the late 1960s, he chaired a Rockingham mental health group that preceded today’s community services board. Peachey was president of Hesston College, a Mennonite institution in Kansas, for 12 years before re-settling near EMU, where he earned a master of religion degree at age 70.

After establishing its psychology major in 1961, EMU gained accreditation for its social work program in 1975. In 1993, the masters in counseling program became EMU’s first graduate studies program outside of its seminary.

As of early 2012, 575 graduates had majored in psychology, 665 had majored in social work, and 221 had earned master’s degrees in counseling. Of course, not all of these 1,461 graduates remained in the mental health arena. This number, though – constituting about 10 percent of our current alumni group – does indicate significant interest in mental health among our alumni.

“EMU has had a long history of training people for service to people who are the most vulnerable,” Tom Martin ’78, a professor of psychology at Susquehanna University, told Crossroads. “If you look around in this society and ask, ‘Who are the most vulnerable ones?’ you’ve got to look at people with severe and persistent mental disorders … It’s really in the Mennonite DNA to do this kind of work.”

Love and Attachment

In the spring of 2011, EMU hosted an unprecedented conference called “Conversations on Attachment: Integrating the Science of Love and Spirituality.” A number of internationally recognized speakers cited the results of several decades of research to support their assertions that caring relationships are as necessary to human life as air, food and water.

With their grounding in the teachings of Jesus, the COs assigned to mental hospitals in WWII knew well the importance of love. Now there is a growing body of scientific proof that love is not just a preferred mode of conduct, it is truly necessary for human survival, as covered in the “Conversations on Attachment” conference. (See more at emu.edu/attachment.)

The integration of science and love is reflected in the life of CO James Kuhns. After his CPS years, he earned degrees in the sciences – chemistry, physics and math – at Goshen College, one of EMU’s peer institutions under the umbrella of Mennonite Church USA. For seven years, Kuhns worked in the scientific arena and earned a master’s degree in physical science. He and his wife did MCC service in Ethiopia for three years. But he found himself longing to return to his CPS days when he was focused on people’s minds. He returned to graduate school and earned a second master’s and then a doctorate in clinical psychology.

Kuhns worked as a clinical psychologist for the next three decades. Interviewed by EMU students as a retiree in Harrisonburg, he said that his life’s work could be summed up in one Greek word, agape, which he defined this way:

It’s to establish a relationship with other people that is positive to help them become what they can become. . . Not in terms of what you can give to me, but [in terms of] what you are in need of. I will nurture, I will encourage, I will support. And if we show that type of love to our associates – whether it’s parents, child, husband, wife, country-to-country, vocation – problems disappear.

This Christian-based emphasis on relationships, on caring, on compassion – on agape – is what caused the Mennonites serving in mental health institutions in WWII to be praised by Eleanor Roosevelt and many of the institutions’ superintendents toward the end of the war period.

Roosevelt also accurately grasped that the CO experience had caused the Mennonite church to open itself to the world and to feel called to service beyond its own cluster of farm communities. Of the male and female Mennonite COs she met, Roosevelt wrote in “My Day” (July 11, 1945):

Many of them are preparing to travel for their churches after the war and undertake relief work in different parts of the world, and what training they get in hospitals here will be of value in the future.
By modeling another way – and calling attention to abusive treatment –  the EMU alumni who served in mental health facilities joined other COs in transforming the way mental health is handled in North America. And they paved the way for hundreds of future EMU students to embrace the importance of mental health, to view it as a responsibility of a caring community, and to make it their own life’s work.

— Andrew Jenner ’04 & Bonnie Price Lofton, MA ’03

For a bibliography, see the bottom of following page. EMU historical librarian Lois Bowman ’60, assistant historical librarian Cathy Baugh, and alumni database specialist Braydon Hoover ’11 offered considerable research assistance for this report on conscientious objectors.

Tim Derstine ’88, MD, medical director of Behavioral Health Services, Mount Nittany Medical Center in State College, Pennsylvania

By Andrew Jenner ’04

Since the very beginning, the conviction that “there has to be a better way” has been a guiding principle for the Mennonite mental healthcare institutions that were established as a response to the experience of conscientious objectors (COs) during World War II.

Mennonite mental healthcare institutions have demonstrated ingenuity and leadership in the face of changing circumstances within the field. Examples over the years include the development of programs to assist in patients’ reentry to the working world, long-term independent living facilities, rehabilitation programs for people with drug or alcohol addictions, and the repeated adoption of new medicines and therapeutic techniques across all programs.

“There’s a much broader emphasis now on additional supports that are needed to help a person live within the community,” said John Goshow ’69, a retired social worker who was CEO of the Penn Foundation from 2000 to 2010.

One recent example of innovation at the Penn Foundation has been the development of  “community treatment” teams made up of a psychiatrist, nurse, social worker and other support staff to provide coordinated care to patients living in their own homes.

“We’re trying to take services to where people are, rather than trying to make them come to some centralized place,” said Vernon Kratz ’57, the former medical director of the Penn Foundation who now sits on its board of directors. “It keeps people in their communities, it keeps people in their families.”

Another example of an unprecedented initiative: Amish leaders approached former Philhaven CEO LaVern Yutzy ’70 and others in that Mennonite mental healthcare institution near Lancaster, Pennsylvania, to discuss the development of a treatment program for members of their community. Their collaboration led to the 2005 opening of a new 15-bed inpatient facility on Philhaven’s main campus for patients from the Amish and other “Plain” groups (referring to their “plain” clothing). To date, it has served hundreds of people from 12 states.

In Goshen, Indiana, Oaklawn opened the nation’s first residential unit to serve adolescents from Amish or conservative Mennonite communities in February 2010. Maria Martin Shisler ’04 is a case manager there.

Alumni at the Penn Foundation: (from left) property manager Tara Paul Detweiler '94; social worker Donald Detweiler '93; psychiatrist and former CEO Vernon Kratz, class of '57; former CEO John Goshow '69; administrative assistant Donna Dittus Massey, class of '81; therapist Lois Styer Halsel, class of '72; social worker Angela Swartzendruber Hackman '03. Not pictured: social worker Maureen Gingerich Bergey '06, nurse Bethany Hertzler '09, and case manager Lisa Moyer Kauffman '89.

Impact of “Managed Care”

Changing conditions within the industry have forced all mental healthcare providers to adapt, sometimes in ways that challenge the survival of non-profit institutions seeking to provide compassionate care for all who need it. The advent of “managed care” in the 1980s and 1990s – through which insurers used new reimbursement models to encourage providers to treat more patients through outpatient programs and reduce the length of inpatient hospitalizations – had a mixed impact.

In 1993, soon after Yutzy was appointed CEO of Philhaven, 82 percent of the organization’s revenues came from inpatient programs. By his retirement in 2008, overall revenues had doubled but the share of inpatient revenue had dropped to just 32 percent. That drastic shift over a relatively short period of time, he says, threatened to sink the institution. A positive outcome, he acknowledges, was that more patients were being treated earlier and with less disruption to their lives.

Insurance reimbursements present a huge and ongoing problem for many of the providers interviewed for this issue of Crossroads. Gerald Ressler ’79, executive director of the Samaritan Counseling Center in Lancaster, Pennsylvania, said that many insurers have reimbursed mental health providers at the same rate for the past 15 years, causing providers to see their real income fall dramatically (on the average, $20 worth of goods in 1996 cost over $28 in 2011). Some insurance companies are even cutting their reimbursement rates. Ressler said that the Samaritan Counseling Center’s largest insurer informed the center in 2011 that it will decrease reimbursement rates by 35 percent in 2012 – a decision that will have a huge impact on the center’s balance sheet.

“Outpatient mental healthcare is as close to being at the bottom of the [insurers’] priority list as it gets,” said Ressler, a licensed clinical social worker who spent 30 years on the staff at Philhaven before moving to his current job.

Gerald Ressler '79, executive director of the Good Samaritan Counseling Center in Lancaster

Additionally, when it comes to public insurance programs like Medicaid, reimbursement rates are simply not high enough to allow practitioners to stay in business if they only see patients on those programs, said Tom Martin ’78, who works as a clinical psychologist in addition to teaching psychology at Susquehanna University. Some practices, including the one in Selinsgrove, Pennsylvania, where Martin now works, have stopped seeing Medicaid patients entirely for this very reason. It’s a reality, Martin says, that points to a key shortcoming in our healthcare system: only employed people have a chance at having decent medical insurance policies. Yet people with serious, untreated mental illnesses tend to have difficulty keeping good, steady jobs with health insurance coverage.

“If you’re affected by a mental condition that prevents you from working, then you will not have ready or consistent access to the best mental healthcare,” Martin said.

Falling in the Cracks

People with serious mental illnesses who need care the most are often left to seek treatment at crowded, publicly funded clinics that often, thanks to the constraints of resources and excesses of demand, struggle to provide quality care. And if, for whatever reason, that care isn’t quite enough, or a patient’s illness hampers his or her ability to apply for and receive public assistance, that person is at high risk of falling through the cracks, where the statistics paint a particularly grim picture of the state of mental healthcare in the United States today:

• Twenty-four percent of inmates in state prisons across the country had a recent history of mental illness, while up to 49 percent of these inmates showed symptoms of mental illness. ¹
• Three times more people with serious mental illness are in jail than in hospitals. ²
• In January, 2010, 26.2 percent of homeless Americans staying in shelters had a severe mental illness, ³ as illustrated by the article on the work of Nate Hoffer ’03.
• The life expectancy of a person with a serious mental illness is 25 years shorter than the national average of Americans.⁴
• After earning a doctoral degree, a clinical psychologist at a psychiatric hospital or substance abuse facility earns a mean annual wage of $69,830, despite the demanding nature of their work and years of study.⁵ With reimbursement dropping, incentives for well-qualified mental health providers are largely internal.

“So many people are just not getting the care that they need,” said Tim Derstine ’88, a psychiatrist and the medical director of Behavioral Health Services at Mount Nittany Medical Center in State College, Pennsylvania.

Tammy Eberly ’80 Bos, a child and adolescent psychiatrist in Grand Rapids, Michigan, noted that a specific recent challenge within the field has been increasing pressure on psychiatrists to quickly prescribe medication to a patient and move on to the next one with little, if any, time for individual therapy. Adding to the pressure, there is a shortage of psychiatrists, making it hard for people – particularly ones without good insurance policies – to receive prompt attention and treatment for mental illness.

This often means that programs, strained by high demand and limited resources, focus on crisis response rather than providing preventive care to patients with mental illness. “We do a lot of cleaning up after things have gone awry for a long time,” Derstine said.

Shortage of Providers

The shortage of treatment providers is more acute in rural areas of the country, and can be partially attributed to the fact that psychiatry is a relatively non-glamorous, lower-earning medical specialty that doesn’t attract as many ambitious young doctors as other fields of practice. (According to the Bureau of Labor Statistics, psychiatrists earned a mean annual salary of $167,610 in 2010, slightly below the average salary for a family doctor and significantly less than surgeons’ annual average salary of $225,390.)

Derstine, who specializes in treating substance addictions, said that the perception that psychiatry is a less serious specialty persists to some degree even within the medical field, and that he spends significant energy working to counter the notion that addicts simply lack willpower or self-control, rather than suffering from an illness as real as diabetes or heart disease.

Among the goals of the Penn Foundation from its inception was public education to put mental illness on par with other medical problems and eliminate the stigma surrounding mental illness. While much progress has been made toward that goal, stigmatization of mental illness remains a challenge for patients and providers.

Progress Has Been Made

Phil Weber '77, a psychologist in private practice in a suburb of Philadelphia

“It’s not as bad as it used to be,” said psychiatrist Vernon Kratz, class of ’57, former CEO and medical director of the Penn Foundation, who is familiar with the appalling way patients were treated during WWII (see pages 2-11). “It’s kind of like racism. We’ve made a lot of progress, but there’s a long way to go.”

Society has become more accepting of seeking professional help for mild depression, grief, troubled relationships and other problems, noted Ressler. Most of the clients at his Samaritan Counseling Center are in relatively good mental health and thus encounter little stigma. More severe forms of mental illness, he said, tend to be more disparaged and feared, as indicated by frequent (and far disproportionate) connections drawn between violence and mental illness in the popular media.

Counselors who see clients from conservative religious backgrounds often encounter the common misconception that mental illness is linked to spiritual or personal shortcomings, explains Lois Shank Gerber ’66, who primarily sees Amish and other Plain clients at Upward Call Counseling in Lititz, Pennsylvania.

Yet another testimony to lingering stigma is a tendency for clients to pay Phil Weber ’77 out of their own pockets when they come for a session. Weber, a psychologist with a home practice in West Chester, Pennsylvania, mainly sees successful, white-collar clients, nearly all of whom have good medical insurance policies. Yet frequently they don’t want records to exist of their mental health treatment, so they don’t file insurance claims. They simply pay him directly. “They don’t want people to know they’re coming to see me,” Weber said.

More Humane, Compassionate

Depending on one’s perspective, someone could reasonably draw wildly different conclusions about the country’s ability to treat people suffering from mental illness. Taking the long view, there’s the fact that, within living memory, mentally ill people were treated like animals in filthy, dangerous and overcrowded state institutions – a situation that shocked the country’s sensibilities once it became widely known. Thanks to the resulting reform movement, both within the Mennonite church and larger society, this model of treatment has been replaced with something far more humane and compassionate.

At the same time, it can be a bleak exercise to focus on the current challenges facing the mentally ill and those who treat them.

Which view is the more accurate?

“The answer is, both of the above,” said Tom Martin ’78 of Susquehanna University.

He concurs with Ressler that today people with less severe mental disorders, like mild or moderate forms of depression, face less stigma and can receive very effective treatment close to home. At the same time, people suffering from severe, chronic conditions – particularly if their illness prevents them from working – face enormous, and even growing, challenges.

Vernon Kratz, on the Penn Foundation’s board of directors, noted that a significant and positive development in the field over the course of his career is that the word “recovery” is in common usage, even for people with serious illnesses.

“There used to be a feeling of despair and hopelessness when [serious] diagnoses … were made,” Kratz said. “I think today there’s much more hope that these can be treated.”

State and federal agencies are seeking to cut expenses, raising concerns about reduced access to care for the most vulnerable people in our society. Yet this is not the first time that the Penn Foundation, Philhaven, and others working in the field have needed to advocate for those who need more supporters. And they know they are standing on the shoulders of earlier advocates for compassionate care for all humans.

“There are a lot of good stories, as well as some really painful ones,” Kratz continued. “[But] overall, I feel fairly positive.”

Able to Survive Challenges

John Goshow '69, chief executive officer of the Penn Foundation from 2000 to 2010

John Goshow, the recently retired CEO of the Penn Foundation, noted that financial uncertainty has long faced mental healthcare providers.

“We’ve been able to survive many different challenges over the years,” Goshow said, adding that church and community support has played an essential role in allowing the Mennonite psychiatric institutions to continue their tradition of innovation and leadership. “If it weren’t for the support of the community, it would be very difficult for the Penn Foundation to stay on the cutting edge.”

At the Samaritan Counseling Center in Lancaster, Gerald Ressler also remains confident that, despite the increasing challenge of dealing with stagnant or dropping insurance reimbursements, his staff will continue to fulfill its mission of offering counseling to anyone and everyone who comes in the door. “We’ll have to be more and more creative to figure out how to provide services, [but] I think we’ll figure out how to make that happen,” he said.

As EMU alumni search for ways to carry on the tradition of Mennonite leadership within mental healthcare, Carl Rutt ’66,⁶ medical director at Oaklawn in Goshen, Indiana, from 1982 to 2003, sees a continuing role for the church-affiliated institutions founded after World War II.

“We convey hope,” Rutt said. “We try to plant mustard seeds until the state agrees, ‘Yes, let’s do this. It’s the right way to treat people’ … I still believe there is a role for the Mennonite institutions.”

And beyond these words, there are also now deeds demonstrating this commitment to continued relevance and engagement. Beside the Penn Foundation’s headquarters north of Philadelphia grows the steel skeleton of a $9.2-million, 32,000-square-foot expansion that will provide much-needed new space for its various treatment programs that long ago outgrew the original building.

“This is a sign of our belief that we will be treating people in our community into future,” Goshow said. And when he says “community,” he means everybody –not just Mennonites, or Christians, or people who can afford the care, or people who look and act a certain way. Everybody, whether they drive a buggy, a BMW, or hobble in on pained feet.

1. Loren E. Glaze, & Doris James, Mental Health Problems of Prison and Jail Inmates (Washington DC: Department of Justice, Bureau of Justice Statistics, Special Report NCJ 213600, 2006), 1.
2. E. Fuller Torrey, et a.l. , More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States (Arlington, VA: Treatment Advocacy Center & Alexandria, VA: National Sheriffs’ Association, 2010), 1.
3. Kristen Paquette, Individuals Experiencing Homelessness, Homelessness Resource Center Fact Sheet (Newton Centre, Massachusetts: Homelessness Resource Center, 2010), Feb. 1, 2012, http://www.homeless.samhsa.gov/Resource/View.aspx?id=48800.
4. Ron Manderscheid, Benjamin Druss and Elsie Freeman., “Data to Manage the Mortality Crisis,” International Journal of Mental Health (2008), 37(2), 49-68.
5. Bureau of Labor Statistics Division of Occupational Employment Statistics. Occupational employment and wages, May 2010. Feb. 1, 2012, http://www.bls.gov/oes/current/oes193031.htm.
6. Though semi-retired Carl Rutt ’66 still sees children, adolescents and adults with a wide range of mental and addictive disorders. Other alumni associated with Oaklawn are clinical psychologist Paul J Yoder ’77, clinical social worker Jeannie Brunk ’83, and psychiatric aide Ryan Graber ’02.

Nate Hoffer ’03, executive director of the Good Samaritan Shelter, with branches in Ephrata and Phoenixville in Pennsylvania

Not long after becoming executive director of the Good Samaritan Shelter in 2009, Nate Hoffer ’03 found himself sitting in the shelter living room in Phoenixville, Pennsylvania, with a young homeless man in the middle of a severe paranoid delusion. Not knowing how to respond, Hoffer wondered exactly what he’d gotten himself into.

“You can’t talk about homelessness without talking about mental health,” said Hoffer. “I certainly didn’t anticipate the extent to which I’d be dealing with it.”

In the end, Hoffer took his client to an emergency inpatient center, where the young man received the care he needed. For Hoffer, it was an early and intense introduction to his new-found role as a front-line mental health worker among the homeless in southeastern Pennsylvania.

At both of the organization’s sites – a men’s shelter in Phoenixville and a women’s and children’s shelter in Ephrata – the staff of Good Samaritan deal more with mental health issues among their clients than anything else.

With no formal training as a counselor or social worker, Hoffer sees his role as a dot-connector between Good Samaritan’s clients and various caregivers in the area. The process can be a frustrating one, though. Thanks to heavy caseloads, the waiting period before an initial assessment can last up to 30 days, during which Hoffer and his colleagues are left to assist clients as best they’re able.

Further delays often result from navigating the insurance bureaucracy, particularly for the many clients going through an initial application process for public assistance programs. At the heart of these challenges is simply overwhelming demand for mental health services.

As the importance of helping clients to access mental healthcare has become clear, Hoffer has begun hiring more staff to provide intensive case management. Staff members have also begun taking a more proactive role in managing medications for clients who need a regular therapeutic regimen to function.

Mental health, Hoffer said, remains misunderstood and underestimated as a major contributor to homelessness. Raising public awareness of this – part of his job as the agency’s executive director – would significantly improve the situation.

“Society could do a much better job of understanding the issue here,” Hoffer said. “The more everybody understands this as a need, the more there’s going to be action.”

— Andrew Jenner

Eastern Mennonite Seminary convocation 2011

The following are excerpts from “An Ethos of Faith and Mennonite Mental Health Services” by Aldred H. Neufeldt, professor emeritus of community rehabilitation and disability studies at the University of Calgary and past chair of Mennonite Mental Health Services. His article was originally published in the Journal of Mennonite Studies, (vol.  29, 2011, pages 187-202), along with many other articles on the history of Mennonite involvement with mental health, including a piece by Titus W. Bender ’57 that covered the 1942-1965 period (pages 45-60). The excerpts are published with permission.

That Mennonite development of mental health services in the post World War II (WWII) period was an intentional expression of faith in action cannot be doubted. The experiences of Conscientious Objectors (COs) working in state hospitals during that war . . . created an awareness within the larger Mennonite community not only about the dire conditions within those institutions, but also a concern that better forms of care and treatment should be available to its adherents and others experiencing serious forms of mental disorder.

As early as 1944 a proposal was put forward to the Emergency Relief Board of the General Conference Mennonites that serious consideration be given to establishing a Mennonite mental health institution, a resolution agreed to in 1945. A similar motion was adopted by the conference of Mennonite Brethren in 1946.
Henry A. Fast, one of the key actors in promoting these resolutions, later recalled:

Our dedication to the principle of nonresistance by itself did not inspire concern for the mentally ill. It did help to intensify our care about people and give meaning, direction and quality to the way we worked with the mentally ill.

These resolutions from two of the largest Mennonite conferences prompted Mennonite Central Committee (MCC) to undertake a study on whether or not to set up mental health services which, in turn, led to a “master plan” to develop a series of centers in the United States.

SEVEN CORE VALUES

The following seven values pertain to the development and provision of [Mennonite] mental health services:

1. Mutual aid. Mennonites/Anabaptists have a rich history of practicing mutual aid in a manner similar to that of the early church as set out in several letters by the Apostle Paul, where the community comes to the aid of the person or family experiencing a significant trouble or loss. Documentation from all MMHS [Mennonite Mental Health Services] centers indicates mutual aid to be the driving concern for their founding… [But] it should be noted that such services weren’t kept exclusive. All centers …almost immediately extended their services to include people in need from other faith and cultural backgrounds.

2. Christian compassion and love. This second value expressed by two related terms speaks to the motivation of personnel for being involved in mental health services. Both terms reflect a sympathetic consciousness of others’ distress together with a desire to alleviate it, and arise out of a tradition of seeking to live a life of discipleship… “Christian love” was the term used to describe the work of COs in mental hospitals and, later, was seen as a primary motivating value in developing of MMHS centers. In practice, the value from early on was expressed in terms of developing a “total milieu” with a Christian emphasis. The first Medical Director of Brook Lane spoke about the importance of “Christian Living” and the impact that staff had on people served: “I don’t see this as ritualistic but more fundamental, incorporating the concept of love, understanding, tolerance and empathy. Each and every member of our organization has a very definite moral obligation in this respect.”

3. Respect for dignity of the person. The phrase “dignity of the person” as an expressed value is relatively recent in origin, largely arising in the 1970s and ’80s in the secular context when disability advocates pursued development of service approaches that were sensitive to individual needs and interests. There is an argument to be made, though, that this value was at least an implicit, if not explicit, part of how personnel sought to relate to people receiving services provided by earlier Mennonite mental health or disability agencies. The theological view that each person is a child of God, no matter what their condition or state of life, has deep roots in Anabaptist tradition. One can infer the presence of such a value in the work by Mennonite COs in mental hospitals during WWII. These were young men and, later, a few women, by and large raised on farms, with little or no training or experience relevant to working in large mental hospitals. Yet, as documented in a recent book on the CO experience by Steven Taylor, they gained a reputation of being able to make small positive changes to life on the wards by showing genuine interest in the persons they served. It is reasonable to argue that an implicit understanding of the distraught, naked, long stay inmates of mental hospitals as each a “child of God” characterized the understanding of these untrained COs seeking to make such individuals’ lives just a little bit better.

4. Community. The communal ethic is widely recognized as a defining characteristic of Anabaptists. Various writings as well as personal observation identify a number of practices in the various Mennonite mental health services that seem consistent with this ethic: placing emphasis on building relationships, trusting others to do “what is right,” sharing resources, seeking to build consensus whenever possible, “servant leadership” and so on…. More recently developed programs continue to strive for a communitarian emphasis, both in their internal programs (transdisciplinary teams, with blurring of lines between professions, were evident within the MMHS and other centers well before they became accepted within the public sector MH programs), as well as in their relationship to the sponsoring Mennonite community and the larger geographic communities within which they exist.

5. Integrity and ethical rigor. An emphasis on integrity and ethical rigor is evident in literature on the earliest Mennonite mental health services to the present. There was an obvious commitment to provide services in such a way that it is above reproach, and to doing what is right and being trustworthy in all relationships… For example, one noted psychiatrist-educator from the New York state mental health system who became familiar with MMHS centers observed: “The staff…whether they were Mennonite or not – were approaching their jobs with a commitment and dedication which I have found to be unique to the programs of the MMHS…although the words were the same, the music was different…. Whether Mennonite or not, personnel were approaching their jobs with a dedication and commitment I have found unique to MMHS.”

Retired EMU sociology professor Titus Bender '57 wrote "The Mennonite Mental Health Movement and the Wider Society in the United States, 1942-1965" in the fall 2011 issue of Journal of Mennonite Studies.

6. Pursuit of high quality programs by incorporating knowledge-based evidence with values. In North America the MMHS centres were preceded by careful study of leading programs in Europe and North America by an MCC Mental Health Study Committee in the years 1945 and ’46.

7. Peace and justice. The young farm COs found that physical and sexual abuse of patients was not uncommon. But far more common was the immense neglect in wards of grossly over crowded institutions where there often was only one paid attendant for 100 to 200 “patients.” According to Steve Taylor’s recent study, somewhat different strategies were used to confront such systemic practices, depending whether COs were of Quaker or Mennonite background. Those of Quaker background gravitated towards active public advocacy, including public exposes of abusive conditions in such national media as Life magazine and others, and prompted development of a highly effective advocacy organization in the USA known as the National Mental Health Foundation. Mennonites felt that tackling systems change was too complex and would not change conditions very easily, and so decided instead to see about changing conditions in small ways on the wards during the war, and on the war’s conclusion to set up their own small mental health facilities. Value statements on peace (i.e. non-violence) and justice (promoting the common good) continue to be present in values expressed by current Mennonite mental health programs, sometimes expanded to emphasize programming that focuses on peace within families.

MENNONITE-STYLE LEADERSHIP

Editor’s note: Aldred H. Neufeldt’s reflections on the history of the mental health movement included observations on the importance of employing leaders committed to Mennonite values, rather than professionals committed mainly to mental healthcare:

The MMHS experience also suggests that if a program had difficulty in finding and retaining key executive and clinical leaders with Mennonite/Anabaptist values, almost invariably its linkage with the sponsoring community seemed to deteriorate with consequent negative impact on their internal social cohesion and ability to deliver quality programs.

That most Mennonite mental health services in the USA have survived and thrived for a period of up to six decades in what surely is one of the most turbulent of human service environments anywhere, with almost none either closing or leaving their Mennonite connections, is a tribute to their ability to retain key leadership, many of whom continue to relate to each other through Mennonite Health Services….

It is useful to remember that the dominant leadership model for mental health services in North America and Europe up until the 1970s was for the senior psychiatrist to be the hospital director. Mennonite programs were amongst the earliest to separate administrative leadership from professional leadership… [The] administrative leaders of the first MMHS centers all had personal experience as COs, and thereby the credibility to launch the first mental health services.

Carol Martin Johnson ’83

She once had a client with severe Alzheimer’s disease who had been an artist earlier in life. During his art therapy sessions with Martin Johnson, he would make large, colorful paintings, but after he left for the day, he’d forget what he had done. Every time he came back, Martin Johnson would show the man his own paintings, sparking his memory and helping him to reconnect with his inner senses of beauty and creativity.

Martin Johnson, an art therapist at the LIFE center in Philadelphia, Pa., recalls the story as an example of an inspiring aspect about art therapy: its focus on what’s right with people, not what’s wrong with them.

“Art taps into people’s strengths. The healthy part,” she says.

At the LIFE center, a day program run by the University of Pennsylvania as an alternative to nursing home care for the elderly, Martin Johnson sees about 30 clients per week in several art therapy groups. Using a variety of different media, people in her classes use art to express, understand and talk about the depression, isolation and grief many of them face, and to remind themselves that it’s never too late to try, to learn, to do something new.

Though Martin Johnson began her career as a nurse, working at various points in rural Pennsylvania, Philadelphia and Uganda, she long felt an urge to put her artistic, creative side to greater use. On her 40th birthday, Martin Johnson began graduate study in art therapy through a program of Drexel University. After completing an internship at the LIFE center and graduating in 2003, she has been working there since.

Her room on an upper floor, overlooking a busy Philadelphia street, is cluttered with paintbrushes, paper, string, glue and dozens of other supplies, but what occurs there is more profound than arts and crafts hour.

Art therapy can give form and shape to difficult feelings, feelings for which there may be no words. It can empower a person to gain understanding of the complex, the hidden, and the mysterious,” Martin Johnson says.

— Andrew Jenner

Nelson Roth ’63

At first, the Crossroads Pregnancy Center in Lewistown, Pa., turned Nelson Roth away. They didn’t have any male clients or need any male counselors. Roth, who had just retired with his wife to Belleville, Pa., after nearly 40 years as a teacher and pastor, left his contact information with the center. If the need arose, he told them, he was eager to volunteer as a pastoral counselor.

Not long thereafter, the first call came, and then another and another. Roth began meeting with men who’d come to Crossroads looking for relief from abusive relationships, broken homes and dysfunction in their lives. The workload grew, and now, nine years later, Roth sees clients four days a week at Crossroads offices in Mifflin, Huntingdon and Juniata counties, plus visits to jails and hospitals.

Though he holds a master’s degree in counseling from Shippensburg State University, Roth says his long experience as a pastor and a gift for sensitivity and connection are his biggest assets as a counselor. Often, the people he counsels reveal painful things about their lives they’ve never told anyone else. And unlike most counselors, Roth says, he does not try to avoid or minimize his own emotional involvement in his clients’ painful lives.

“We have Jesus to be our strength,” he says. “I don’t carry the load emotionally, because it’s up to the Lord … Scores of clients have experienced Crossroads as a place of learning, decision and new life in Jesus.”

In 2008, Roth was recognized for his work when he traveled to Washington D.C. to receive a Presidential Volunteer Service Award. He lives in Belleville with his wife, Emma Jane, and is active in the Allensville Mennonite Church. In addition to seeing clients through Crossroads Pregnancy Center, Roth also regularly volunteers as a counselor to members of his congregation, and is sometimes assigned clients by a judge in Mifflin County.

The past nine years have been a unique opportunity, which has resulted in a new kind of personal crossroads in my life,” Roth says. “I daily seek God’s mercy, grace and victory, both for myself and my clients.”

— Andrew Jenner

Dorcas Stoltzfus Morrow ’56

Every inch of tabletop space in Dorcas Stoltzfus Morrow’s apartment is covered with loose papers and three-ring binders, spillover from the crammed bookshelves that surround her living room at Landis Homes in Lititz, Pa.

One of the first women to complete a full pre-med program at EMC, Morrow enrolled in the fall of 1956 at The Women’s Medical College of Pennsylvania (now the Drexel University College of Medicine). Five years later, after completing an internship in West Chester, Pa., Morrow shipped off to Africa as a missionary physician with Eastern Mennonite Missions. Suddenly this petite woman still in her twenties was often the only doctor dealing with cases ranging from complicated births to malaria and other tropical diseases. From late 1961 to early 1964, she worked in obstetrics and pediatrics based at a mission hospital in Shirati, Tanzania. Next, Morrow went to Jamama, Somalia, where she worked for a year and half at another hospital run by the mission board.

Morrow then returned to the U.S. long enough to spend another year in Harrisonburg doing seminary studies, before heading back to Pennsylvania where she dabbled in surgery but ultimately entered a full OB/GYN residency in Harrisburg (a career in surgery, she’d decided, seemed like it would have been too hectic). By August of 1970, she was back in Shirati for another service term of a little more than two years – during which  she had some fantastic adventures, like the time a flying doctor service dropped her off to call on patients in a remote village but never showed up to pick her up, eventually forcing her to borrow a bicycle and trek back to civilization on her own.

Back home for good by 1973, Morrow ended up marrying the husband of her first-year roommate at EMC, who had died of breast cancer. Suddenly, at age 43, she was the mother of four children – three in high school and one in elementary school. She spent the next decade as a physician for the school system in Philadelphia, during which time she became ill, went to the doctor and discovered she was pregnant. Soon thereafter, at age 47, she had her first and only child.

When her son was still young, it was dawning on city school officials that physicians were expensive people to keep on staff, and Morrow could see the writing on the wall. Soon, they’d have a nurse doing her job. It was time to explore another long-held fascination: psychiatry.

This interest dated back to her undergrad years at EMC, when an uncle of Morrow’s, suffering from a debilitating mental illness, came to live with her parents as an alternative to institutionalization. Her uncle did well there and ended up staying for years, regaining relative independence and good health and serving as inspiration to Morrow 30 years later. At age 53, she began a three-year residency at Norristown (Pa.) State Hospital in 1984. After finishing that program, she worked there as a psychiatrist until she qualified for the state retirement system and, in 1998, was able to hang up her white coat.

“I was always kind of late getting into things,” says Morrow, chuckling as she reflects back on the life she’s led, now spread in a fantastic jumble of documents around her as she works to set it to paper.

— Andrew Jenner

Emory ’70 and Idella Borntrager ’68 Otto

To be an effective counselor, says Emory Otto, “you really have to care about people, and really want to help people.”

It’s something that he wanted to do since he’d been in elementary school, and it’s a career he pursued since majoring in psychology at EMC and earning his doctoral degree in 1983 from the Florida Institute of Technology. As he discovered in the intervening three decades, it can also make for long days of exhausting, stressful work on a relatively modest salary; the reward has to be something other than money.

“It’s a ministry,” says Emory, sitting on the couch in his basement office.

“This is our love gift back to God and his people,” adds his wife, Idella Borntrager Otto, who, much later in her working life, trained as a counselor and joined her husband in a practice run out of their home in Lititz, Pa.

After starting his own practice in 1999, Emory began to realize that practicing jointly with a woman therapist would allow him to better serve his clients. Idella, meanwhile, was working as a school nurse, where she increasingly found herself working in an informal counseling role. Many of the students who came in complaining of headaches, she thought, really were suffering from heartache caused by stressful home lives.

The next step seemed obvious. Idella, who already had plenty of practical counseling experience, formalized her training through the American Christian College and Seminary. After graduating in 2005, she and Emory practiced together until her retirement in 2011; Emory is currently in the process of winding down the practice for his own retirement. // Their deepest joy while working together, they say, was accompanying their clients on healing journeys that often unfolded in unexpected, unlikely ways.

“Sometimes people’s pain was so deep that they couldn’t see how God could redeem their situation, but He did,” Idella says. “No pain is too deep that God’s love can’t reach it.”

— Andrew Jenner

Elaine Zook Barge ’84, MA ’03 (left), & Carolyn E. Yoder ’72

Strategies for Trauma Awareness and Resilience (STAR) emerged from the ashes of Sept. 11, when hundreds of millions of people were grieving over the deaths and destruction caused by hijacked airplanes flying into the World Trade Center in New York City and the Pentagon in Washington D.C.

To mark STAR’s 10th anniversary, founding director Carolyn E. Yoder ’72 collaborated with current director Elaine Zook Barge ’84, MA ’03 (in conflict transformation), to produce a 38-page booklet, STAR – The Unfolding Story, 2001-2011, that explores the program’s astonishing growth. The teachings of STAR are also outlined in the booklet, which is available as an e-book at emu.edu/cjp/star.

STAR began when Church World Service asked EMU’s Center for Justice and Peacebuilding (CJP) to design a trauma-training program for civil society leaders whose communities had been affected by Sept 11.

In developing STAR, Yoder tapped the expertise of the professors at CJP, as well as of experts in religion, psychology and neurobiology in the larger community. She came as a licensed professional counselor, also licensed in marriage and family therapy.

parked by Yoder’s quest, CJP began to break down disciplinary boundaries, melding the principles of restorative justice, conflict transformation, trauma healing, and religious faith into better practices for positive change. The result was a week-long training program to raise awareness of the links between trauma and cycles of violence, along with ways to de-couple those links and thereby emerge from the cycles.

I work and live in an inner city where people have experienced multiple layers and kinds of trauma,” said New Jersey pastor Sheila Holmes in the booklet. “The youth are very angry and frustrated. All the STAR materials have been helpful in my work. The most helpful in my community is the understanding of ‘abnormal becoming normal’ and how we just come to accept that and don’t realize we can be set free.”

As STAR’s first director, Yoder facilitated over 50 trainings with about 800 people from 60 countries during STAR’s first five years. The number of people who have now taken STAR tops 7,000.

“The general perception is that trauma healing is soft, a warm fuzzy, that it has little or nothing to do with realpolitik and no role to play in reducing violence,” wrote Yoder in her 2005 book, The Little Book of Trauma Healing. “Yet trauma and violence are integrally linked: violence often leads to trauma, and unhealed trauma, in turn, can lead to violence and further loss of security.”

— BPL