Host Dr. Flowers, Co-Host Robin French, and VIP Guest Dr. Ross Ellenhorn discuss Dr. Ellenhorn’s work helping people recover from the traumas caused by psychiatric treatment and the application of psychiatric diagnoses. Dr. Ellenhorn shares details regarding his new passion/project – a new Psychedelic-based center.
Key Takeaways:
03:07 – What is Community Reintegration?
06:35 – The Trauma Caused by Psychiatric Treatment
09:33 – The Fear of Hope
11:56 – The New Ways of Thinking About Extreme States of Mind and Mood
15:41 – The Creative Side of Psychotherapy
17:05 – How We Change: (And the 10 Reasons Why We Don’t)
23:19 – Community Integration Program
24:58 – The Purple Crayons: The Art of Drawing a Life
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Rehumanizing Psychiatric Care: The Profound Power Of Pathologization With Ross Ellenhorn – Episode 39
Hi, Robin. How are you?
I’m good. How are you?
I’m great. I’m excited to have Dr. Ross Ellenhorn with us on this episode.
Yes, welcome.
Thank you for having me.
Thank you for coming to the show. I’d like to read a little bio if I may. I’m sure most of our readers know who you are, but for the few moms out there who don’t, I’d love to read your bio. For the past three decades, Dr. Ellenhorn has been a pioneer and leader in the development and promotion of community integration services.
Types of care that serve and empower individuals diagnosed with psychiatric and or addiction issues while they remain in their communities and outside institutional settings. Dr. Ellenhorn is the founder and owner of Ellenhorn, the most robust community integration program in the U.S. with offices in Boston, New York City, and the Raleigh-Durham area of North Carolina.
He has authored two books on human behavior. He is the co-founder and president of the Association for Community Integration Programs, a professional association representing and promoting programs dedicated to empowering clients who are receiving services while living and participating in their community. Dr. Ellenhorn is the first person to receive a joint Ph.D. from Brandeis University’s prestigious Florence Heller School for Social Welfare Policy and Management and the Department of Sociology.
There is much more to his bio than that. Hopefully, we and the readers will learn more a little bit about you. Amazing bio and you are known for community reintegration programs. I’d love to help our readers understand what that means. Community reintegration.
Community Reintegration
First of all, when I hear that bio, I just sound so Impressive. My self-esteem goes way up and then I have to remind myself that I wrote that.
That is fantastic.
It’s something about self-affirmation that I still feel good about myself after hearing my own words. I’m trained as a Sociologist. I am interested in what happens to people when they’re treated as mentally ill. A good amount of the things that we associate with mental illness, especially issues around motivation and the willingness to accept help.
If those things are not mental health issues, but social issues, there is a significant amount of social psychology on what happens to a person when they feel ostracized or when they feel stigmatized. Sadly, if you ask most mental health patients, “Who are the people that are ostracizing?” They’re going to tell you that it’s the treaters. It’s the doctors and the social workers.
There’s something that we think of as a psychosocial trauma that we feel that we are dealing with people who have gone through a real significant problem in their lives where they became outsiders and sadly our profession is the profession that decides who is an outsider and who is not. Labels. Community integration is about how you keep this person actually in the community, continuing on their course in life, instead of being placed outside of that course, and still treat them for these extreme events of mood and mind. That’s the idea.
We work with people who might be considered appropriate for a residential program or a hospital. We’re treating them in the community because we have these strange ideas that purpose and meaning, in a sense the connection, have to do with your well-being. I’ve probably gone on too long right now already, go ahead.
No, no.
Are you saying that instead of being in this brick wall, or this facility-type program, instead of being in a false environment and not in vivo?
Your podcast is on the human condition. Here’s one very simple thing we know about human beings, they’re living. You cannot predict the growth of a living being. You cannot prognosticate about it. You can’t decide where they’re going in their growth. You can pretty much tell what an illness is, and you can label that, but that’s less important than growth and a person’s movement forward.
You cannot predict the growth of a living being.
The other thing we know about living beings is that because they’re constantly changing and moving forward, they live in ecologies, and they’re part of the world. They’re taking in the world and also producing into the world. We live in a system that treats human beings as if they’re not human beings but things.
When they’re broken, you send them to a factory or a place where they get fixed. There are certain tools we use there, and if those tools don’t work, we assume that they’re too broken to be fixed. it’s a factory orientation. Psychiatry and mental health care is a factory orientation. It’s the orientation of what we do to things, not living animals or beings.
Talk to us about the trauma caused by psychiatric treatment that you see.
Psychosocial Trauma
I believe that a lot of things we associate with the negative symptoms of schizophrenia may be a person who’s in despair, a person who has lost hope, and a person who has been beaten badly by ostracism that they’ve given up making contact with people. When we talk about clients who are difficult to engage, we’re talking about people who are not trusting us, and for good reason often because the thing that’s difficult to engage is our treatment.
We don’t come to their homes, we don’t come to them. We make them go to places, again as things, and then we try to fix them. A lot of that trauma has to do with motivation. I don’t want to move forward anymore. I can talk to you a bit further about that if you want because my research is on this thing called fear of hope.
What we call a perturbed relationship with health. For me, I think everybody needs to learn how to accept help. If a client from my program accepts help from a shaman, I’m as happy as if they accepted help from a psychiatrist. The point is, can you receive, accept, and metabolize help? If somebody has been injured by these systems of care, they stop wanting to take in help.
Those are the two symptoms of psychosocial trauma. There is remarkable research by this guy named Kipling, who played this game called Cyberball. What that is, is that they get on a computer and they play against two other supposed people, but it’s just a program. They don’t know this. Those two people throw a ball and then throw it to the subject. The subject throws back, and then those two people just start to throw to each other only.
The person is in an fMRI machine. Some part of their brain that responds to pain is all lit up. You got to get back to the tribe, you got to get back to the group, you’re in trouble. Now, Williams tells people, “You’re playing a game and there’s no two other people in the room.” The same thing happens. That’s how the cue in our brain is to accept, be involved, and be connected.
Research on loneliness is the same thing. The research on loneliness is that loneliness is a feeling that’s trying to get you back to the group. That’s why loneliness, when it keeps going, is just as much the cause of heart disease as cholesterol and smoking 17 cigarettes a day. All the cortisol in your system is telling you to get back to the group because you’re on the outside.
I was intrigued by the phrase, “Fear of hope.” Is that something similar to self-sabotage? Tell us about your research on fear of hope because it sounds interesting.
Sadly, I’ve been told I can’t talk too much about the results until the thing’s published, but I’ll take my version of it because it comes from my version. My version and the social psychologists at Rutgers University were part of a team and we’re studying this. We’re showing that hope is an important psychological resource.
Hope is the emotion that pushes you through uncertainty. That’s what it is. It’s the thing that when things are uncertain, you’re able to get through it because this emotion is pushing you through. We’re showing that a person can have high hopes but can be terrified of that high hope because there are so many disappointments and that their fear of hope can lower the curative effect of hope.
Even though they’re high hopes. What we’re discovering is that the people who are in the worst shape are not the people who have low hope and high fear of hope, it’s the people with high hope and high fear of hope. They’re agitated people. They come into your office, and you meet with them for therapy and tell them that all good things can happen in their life. You’re giving them lots of hope, and all you’re doing at that point is terrifying them.
The people in the worst shape are not those who have low hope and high fear of hope. It’s the people with high hope and high fear of hope.
Then they’re responding, and they’re saying, “I don’t want to hear what you have to say.” “I don’t want to change.” You’re saying to them, “You got to pull yourself up and move forward.” You’re just terrifying them further. We’re in this place in therapy where if we can respect what’s going on for people, it is often this fear of hope, that we can get to another place with them. Understandable phenomenon. Does that make sense?
Absolutely. I would assume that that carries over into physical health and medical health as well. Same thing. That fear of hope. Chronic diseases, cancer, chronic pain, all of that. If someone has that fear of hope or a fear of getting better.
Right, in the area of problematic habits, people are afraid of their sobriety because they’re afraid of the point where they lose it. When you’re talking about self-sabotaging, another way of thinking about it is fear of hope. It’s not something any of us are freed of. You don’t see a theologian out there saying, “Hope is easy.”
That’s right. Absolutely. Thank you for that. Dr. Ellenhorn, also talk to us about new ways of thinking about extreme states of mind and mood.
Extreme States Of Mind And Mood
I think that one way of thinking about it is that there is no one schizophrenic, or there’s no one with bipolar disorder. There are human beings that are having these experiences. If we begin to think of them uniformly, we’re probably hurting them. We’re also hurting our ability to have a collaborative relationship with them. All good treatment happens from a collaboration. This is just the truth. All the research on common factors in therapy says that it’s the collaboration that matters.
The 15% of what works in treatment has to do with the model you use and 30% has to do with the collaboration. The minute you’re telling a person they have a thing that they’re suffering from is the minute you’ve broken down that collaboration. Instead of a conversation about what this experience is like for them and what their relationship is with that experience. This is where diagnoses get us in trouble, instead of trying to get into the person and their experience of this thing.
You’re talking about collaboration, patient-provider, and provider-to-provider collaboration.
Yes, we are the worst profession to collaborate with.
I agree.
I have to ask because I’ve been curious since I read about this, what is a psychedelic-based center? Can you educate the readers about this? I was dying to ask you this.
Where’d you find that? I don’t know where you found it.
If you want to pass on that, you can.
No, I don’t mind. I had this idea that I was going to start a program separate from mine with some people in New York City who both took a more creative approach to the use of ketamine to help people with certain issues. Also did work with psilocybin in other countries where it’s legal. I was sure that if I did this, it would hurt my reputation because basically, Ellenhorn’s becoming a hippie. Ellenhorn’s in trouble. Do you know what? Every single hospital in this country is now looking at this. Every single university was looking at this.
When did you start looking into it?
We started working on this company about a year ago. It was just at the beginning that maps were taking hold, where the Michael Pollan book came out, which is just a very important book on psilocybin. By now it’s everywhere. Two articles in the New York Times just this month. Everything’s moving that way. I’m now feeling a little less like my reputation is going to get hurt by doing this.
I would agree. I used to have that same fear of working in pain and talking about things like that and ketamine. Ketamine is used in chronic pain patients all the time. I used to have that fear of, “My goodness. If I use ketamine or we prescribe ketamine to our patients for their chronic pain and chronic depression, I’m going to be ostracized from the recovery community. What’s everybody going to think?” Now it’s mainstream.
The Creative Side of Psychotherapy
With its dangers, because it’s mainstream. In Massachusetts, we have this thing called Gentle Dental, these chains of dentist offices. What if ketamine becomes like Gentle Dental? People go in only for the ketamine, not for the therapy part. What are they doing? They’re going once a week to get anesthetized, which means it’s pretty close to drug abuse. It’s legitimized.
How do we keep it within the realm of therapy? How do we protect it so that’s helpful? Our program is about doing that and remembering the creative side of psychotherapy. Psychotherapy has always been an art. How do we keep it within that artistic realm of recovery in our work? That’s what we’re doing also in these other countries. I’m working with people who have been doing this stuff for years underground. These guys are now working with me and we’re doing this in these two different places.
That’s great. I can’t wait to watch and talk to you more about that.
Didn’t you say on one of our shows, that dentists were one of the top prescribers?
No, probably what I said about dentists was they’re the top prescriber of Vicodin.
How We Change: (And The Ten Reasons Why We Don’t)
That’s right. Tell us about your book because you’ve got two books, but the latest one, How We Change and The Ten Reasons Why We Don’t, tell us about that book. It’s out this month, right?
No, it’s a year old. I had the wonderful distinction of publishing a self-help book on May 21, 2020, which is probably the worst point.
That’s why I thought it was this year. I missed a year.
Harper Collins would have me write these editorials or these off ads that tried to make my book seem like it has something to do with the pandemic. Then they finally just threw up their hands and said, “Forget it. There’s just no way to make this happen right now.” Decades ago, I had this group of people who were in a Day Treatment program.
I used to ask them, “What are the reasons that get in the way of changing?” None of them talked about their symptoms. All of them talked about these issues of the pain of expectations and the pain of getting their hopes up. They fear being seen as in charge of their lives because then people will get more excited for them. Then that turned into this research on fear of hope.
The book is just taking those reasons, the ten reasons not to change, and offering to the public as something that we all do. We all worry about, what it means if I move forward. What will it mean to others? What will it mean to me? Am I heading towards another disappointment? That’s the basic idea of the book.
I love that. Robin?
I was just going to say that the fear just paralyzes them and that’s just the beginning, right?
Yes, I can tell you another way of looking at it, which is my theory, and it’s an unproven theory. This concept of an attachment disorder. First of all, I don’t know what attachment disorder means because I don’t have any ordered attachments.
We can talk about what they are later.
I think that if I ever met an ordered personality, I’d find it boring. I don’t know anybody whose character is ordered. I don’t know what these things mean but what if attachment issues are hope issues? What is that infant doing when it reaches for its parents? It is making a gesture of hope. It is reaching out and making hope.
When you hope for something, you’re always making that thing important. Before you hope, it’s less important than when you hope for it. It’s setting itself up to fall into a deeper disappointment. That disappointment is the experience of helplessness. I can’t feed myself. I can’t get fed. I can’t make my life work.
What if what we mean by attachment issues is hope issues, a person who’s afraid of reaching out and getting their needs met and also feels like they’re incapable of it? I’m too broken to drive the bus that is my life. That to me makes more sense than it’s because the attachment wasn’t made. It’s because the hope was disappointed. I think that a profound part of all of our existence is this fear of being out there and trying and then being disappointed.
Tell us about Ellenhorn, the practice.
If you think about a person who has had significant extreme experiences of mind and mood, they need a lot of help psychiatrically if they’re going to integrate into the world. They need a whole team around them that gets them to class, meets them afterward, maybe brings them home, and spends time with them.
They need a psychiatrist who’s thinking about their care sensitively, making sure the side effects aren’t too great, and making sure the meds are working. We call ourselves a hospital without walls, but we’re not a hospital without walls. We’re an organization that’s trying to keep a person in life while you’re moving forward.
We call ourselves a hospital without walls, but we’re really not a hospital without walls. We’re an organization trying to keep a person in life while you’re moving forward.
We use this model called PACT, which is a model that came out of Wisconsin. They shut down a hospital, took the clients and the staff from that hospital, and put them in the community. What they discovered is if that staff is constantly communicating and meeting every morning, over the last 24 hours, and if all the care is provided by that staff and if it’s mobile, people don’t need to be in the hospital anymore.
We are taking PACT to well-resourced families. Well-resourced families don’t have community mental health. They don’t have a place to go. The bridge between a hospital and a psychiatrist. We’re the place where they can have that sense of communal health. Continued care changes and shifts depending on what they need and all of that.
Sounds amazing. You guys are in more than one city?
We’re in Boston, New York, Raleigh Durham area, and now Los Angeles.
You’ll work with anyone probably anywhere around the country. Is that right?
Right. Different places. Nobody’s going to go to New York City for the mental care. New York City is for New York City. We wouldn’t want somebody coming to New York City for this care. Boston’s all over the world, all over the country. North Carolina is. LA is too, but LA is also very LA. There are a lot of people that we can get from LA that will work with us.
Wonderful.
You’re also the co-founder and president of the Association for Community Integration Programs. Can you tell the readers about the association and what that’s all about?
Community Integration Program
Sure. I was interested in trying to get this philosophy spread, this idea that people don’t need to be in institutions or residential programs. Six or seven years ago, I created this program. One of the places that we’ve influenced is the Menninger Clinic. They now have a PACT program like ours. That means a lot to me that a hospital is doing this work now out in the community.
That was the purpose, to spread the word about this. We made a rule that if you were going to be part of it, you couldn’t be connected to a venture capitalist. We were very worried about this movement in mental health where nonclinicians own programs. We created this place that was trying to protect the brick-and-mortar places. We did take on a couple of places that had fine financial people behind them, but they weren’t allowed to vote. We liked the places so much that we took them, but they don’t get a vote on the place because we want to protect the spirit of this orientation.
Amazing work that you guys are doing. What do you like to do in your time off? Which is very little time.
Do you travel a lot?
Not last year.
In the normal world.
The Purple Crayons: The Art of Drawing a Life
I’m writing a new book. Do you know this book, Harold and the Purple Crayon? Absolutely. That’s with HarperCollins too. I think I’ll have it done by mid-June. It’s about this concept called Sacred Originality, which is the idea of how you get to the source for each person. How that source is sacred and how do you protect it? I walked through this children’s book and told that story. Then the opposite of that story, which is remarkable. Harold and the Purple Crayon. The opposite stories of Aryanism, consumerism, and conformity. It even tells that in the story.
There’s a reason for that, which is the book was written in 1955 and people were writing about that stuff like crazy back then, people like Erich Fromm, Ivan Illich, and Herbert Marcuse. There was a whole scene of people who were worried about Uniformity then. 1955 was the year that McDonald’s and Disneyland opened. Coke was put in cans. Right out all over the place. There was this period when people were very worried about uniformity and conformity and this book comes from that period.
It’s like a little message in a bottle to look back and say, what have we lost and how can we again, understand the sacredness? What Martin Luther King called the sacredness of human personality, the uniqueness in each of us. How do we preserve that and how do we support that? When I think about what I want for my clients in my life, I don’t think about pathology as much as I think about how you get to that core uniqueness.
Then how do they get back to themselves? How do they thrive? Dr. Ellenhorn, thank you very much for taking time out of your day and all of the things that you do. You were amazing yesterday when you thought the podcast was yesterday and you were great with that.
You are cool about that and that you answer your telephone and I want the readers to know that the first time I called him, I picked up the phone and fully expected to leave a message, but he answered the phone. I didn’t know what to say.
Did you ever watch Mad Men? Do you know the old guy that would just sit around in his office? The secret is that, that’s the life of a CEO. You sit around waiting for people to call. That’s the secret. I learned this from a CEO. He said, “CEOs don’t have to get them. They just sit around. You don’t want anybody to hear this either.”
No, I love that. That’s my day.
We share an office, I know it’s a day.
When you called, I said, “Someone needs me.”
That was sweet. I was impressed he answered his phone. That’s cool.
We would love to have you down to Houston and not only visit Menninger but visit J. Flowers Health Institute when you have time. Thank you for this incredible interview and the time you spent with us on this episode.
Thank you, it was a lot of fun.
If someone wants to reach you, what’s the best way to reach you? You might answer the phone, right?
They can email me. It’s [email protected].
Excellent. Thank you again for being on the show. I hope next time we can do this in person. We tried to get you here in person, but you were just too busy. I’d like to remind everyone that there are numerous platforms to find our podcast, YouTube, Apple Podcasts, SoundCloud, Spotify, Stitcher, and iHeartRadio. Please help us out by subscribing to our podcast, liking it, and sharing it. Thank you.
Thank you, everybody. Thanks much. Take good care.
Thank you, Dr. Ellenhorn.
Thank you.
Important Links:
- Dr. Ross Ellenhorn – LinkedIn
- Ellenhorn – Website
- [email protected] – Email Address
- Mentioned Books:
- How We Change, and The Ten Reasons Why We Don’t
- Harold the Purple Crayon
