Can you give us an overview of your current job and duties?

The clubhouse model rehabilitation is a non-clinical, psycho-social approach that is peer-run. It’s based on allowing individuals with serious illnesses, who either just got out of the hospital or who have been in mental health systems for a long time, wherever they may be, to take the reins of running the organization, get all the tasks done, make all the meals, do all the hiring, support the grant writing, data entry, etc. So my role as staff is to facilitate that, to help members find their niche in the community and in the organization, and to feel empowered to take on their own roles and responsibilities. I facilitate their socialization process, getting them comfortable with other people and with their place in the community.

That is fantastic. When did you first encounter Becker?

I first heard about The Denial of Death from Marc Maron’s podcast; he talked about it a lot as being a seminal text for him. When I read Denial of Death, I reoriented and reframed all of my thinking in a big way.

How have you seen Becker’s ideas playing out in the setting where you work?

In terms of mental health or serious mental illness, I think the terror manifests in the sense of realizing that your body is betraying you, and realizing that your brain is betraying you, and it’s sabotaging your identity, sabotaging your ability, and taking you out of the life you built for yourself. So then the question is, do you either embrace those limits entirely and just become sort of a perpetual patient, or do you reject the patient entirely and just live as if there weren’t any limits? But the latter is going to kill you. So I see that mortal terror in the context of people just not knowing how to grapple with something that could destroy them, or has sort of already destroyed them, and then trying to get some semblance of a life back. What does that strive for uniqueness and immortality look like when you can’t even trust your emotions or your brain? So that has been the biggest challenge that I’ve seen here looking at it in the framework of Becker.

Do the members ever acknowledge this duality?

Yes, people are very aware of it. It’s very much ingrained in the Clubhouse philosophy, this sort of running up against your limits. The whole Clubhouse philosophy is about combatting internalized stigma that you’re just a diagnosis and you’re utterly that condition. So what the clubhouse tries to offer people is an opportunity to reconnect with either the identity they had before, or a new identity based on a different orientation. It’s about restoring that sense of unique ability to somebody who has been treated and told, and also experienced through the terror of the disease, that they are just something that their body has locked them into and nothing more.

The whole Clubhouse philosophy is about combatting internalized stigma that you’re just a diagnosis and you’re utterly that condition.

There’s one line from Becker that I think of always: “…in order to have a truly human existence there must be limits.” That’s something I think about a lot here. You realize that you are bound, that you do have needs, and especially for people who are manic or bipolar or schizophrenic, this is so much of the challenge—accepting that you do have needs and abilities. Once you have that awareness, then you can start trying to live a life that embraces both.

In talking about neurosis/mental illness, Becker says, “In the first place it refers to people who are having trouble living with the truth of existence.” Do you find this applicable?

Oh so much, you have no idea. With severe mental illness, the filters through which we view the world that have become “typical” or “normal” are unavailable, or not utilized or desired, in those with severe mental illness. So it is a much more exposed existence in that way. We have these filters because there are adaptive benefits to being able to restrict and deny our emotions, and things like that, but does that make it “normal” vs. “pathological?” With mental illness, there is a deep profound awareness that most of us don’t have access to because we have the ability, or the awareness or the willingness, to just push it away or into a train of thought that tells us what to do.

What does that strive for uniqueness and immortality look like when you can’t even trust your emotions or your brain?

Do you think the setting and isolation of mental health institutions can sabotage the treatment?

Oh, 100%. We know that the biggest determinant of serious mental illness besides genetics is social bonds. There are studies showing that the incidence rate of schizophrenia is lower in east-Asian countries for example, and maybe it has to do with how they structure their communities. There are also many studies demonstrating that self-care and mental health regiments are done so much better in Clubhouse communities.

If you have a strong social community, you’re not going to travel inside of your own head nearly as much until it becomes a problem. You’re going to have people who can keep you connected and keep you outside. And again, going back to Becker, it’s all arbitrary; it’s an arbitrary community where you’re placed, and the people you end up talking to, but it gives you your sense of reality and your worldview, vis-à-vis the existence you’re able to affirm and mirror in other people. Nothing is more real than community. I think that’s why Becker is addressing this one-two punch of the death of god and the death of the intimate community. Because after that, what’s left for people to feel connected? If your major value system is gone and the major reality is gone, then you’re going to lose it. A lot of existential therapy is focusing on how “man wants purpose.” But, that’s the same thing as wanting immortality. Man wants definition, roles, uniqueness—all of these are derived from a desire for grandiose importance and immortality.

With mental illness, there is a deep profound awareness that most of us don’t have access to because we have the ability, or the awareness or the willingness, to just push it away or into a train of thought that tells us what to do.

In closing, after seeing Becker’s ideas play out in your personal and professional life, what is your relationship with your own mortality and death anxiety?

The answer I have found to fear of death is a connected life. My philosophy is to confirm the existence we have here by living it with other people, and that’s the best answer that we can get to addressing our mortality; you’re mortal with everyone else. I’ve mostly stopped thinking in terms of “immortal uniqueness;” that just doesn’t have the personal sway—giant thanks to Becker—that it used to have. The biggest thing is just remembering that the dissonance comes from the limits that you’re pressed up against all the time. Seeing how to live and work within those limits is the biggest take-away I’ve gotten from Becker, both personally and in my work.