One spring day, a musician who goes by Jack called me to offer a good-news story. People can heal from mental illness, alcoholism and homelessness, he said.
For nearly all his 52 years, Jack said, hope was a luxury, something for others, not a beaten-down drunk sleeping on Portland’s streets. But Jack’s hope bloomed this time when he woke up on a mat in an eastside warming center and decided to investigate sobriety, again.
For his four decades in medicine, psychiatrist Philip Shapiro has confronted mental illness at its most intractable in the most desperate people, many self-medicating for years with cheap wine or meth.
Shapiro practices at 12th Avenue Recovery Center on the downtown corner with Southwest Stark Street, a clinic that annually serves 500 mentally ill, indigent Portlanders.
He hung up the white lab coat years ago and presents himself at the clinic in twill pants and pullover sweater. At 67, he is yoga-wiry; a silver hoop glints from his right earlobe.
All week, he sees clients in a small, dim, windowless office and prescribes anti-depressant, antipsychotic and mood-stabilizing drugs. But more than that, he counsels them to draw upon an even stronger healing power that they already own.
“The mind is a marvelous machine for recovery,” Shapiro says. “There is more and more research every year showing that this connection helps us experience healing power and manage pain. I knew that from my own experience. That was the medicine I wanted to practice.”
A component in Shapiro’s approach is a space just steps from his office. The Living Room provides a homey respite for the isolated and shunned to leave the street or their tiny rooms for a brief social experience. Big windows facing Stark Street fill the room with light. There’s a small kitchen, an upright piano, soft sofas, tables for people to sit around and play bingo.
There isn’t enough money to open the Living Room more than three mornings a week. But on those days, coffee and free doughnuts entice clients to venture in. Then Shapiro enters and drops onto the sofa to lead hourlong group sessions on recovery, healing and spirituality.
About a dozen clients settle in for the conversation, although not the same ones every day.
“Hello,” Shapiro says one morning. “Anyone want to talk about a healing quality you’re working on?”
“Yeah,” says one man in heavy overcoat and ancient denims. “I’m trying to find some peace.”
“That’s a good one,” Shapiro says. “You know, peace is on the other side of every painful problem.”
On the day Jack promised himself to stay sober, he went to Central City Concern, the nonprofit medical clinic-housing agency in Old Town caring for 13,000 poor or homeless people. In succeeding weeks, a doctor treated his arthritis. A social worker got him into an apartment at Central City’s Madrona Studios. Another helped him apply for Social Security Disability Income.
Jack said he got sent over to 12th Avenue Recovery to be assessed for mental illness. Reluctant, he went first for the doughnuts. Then he heard Shapiro talking about the mind healing the body, and Jack stayed.
“This was something I’d been struggling with for years, what’s going on in the mind,” he said. “For the first time, I heard someone talking about this, and I thought, hey, this is for me!”
Jack became a regular at Shapiro’s group sessions, and the doctor gave Jack a copy of his book.
In “Healing Power: Ten Steps to Pain Management and Spiritual Evolution,” first published in 2005 and just revised, Shapiro describes his views of how the mind and body can together heal illness.
Erasing the mind-body duality is relatively new in Western medicine, but every year, fresh clinical evidence arises that people with spiritual beliefs, no matter the variety, heal faster than those without. Shapiro’s advance is to present the concept to the chronically mentally ill and communicate his belief, every day, that they can heal their ailing bodies and anguished minds.
The book, Shapiro writes, presents “healing principles and methods I have extracted from the great wisdom traditions and organized into cognitive-behavioral practices. These techniques are designed to help the reader transform any troubling problem into spiritual power.”
He compiled a list of 100 “healing qualities” — No. 47 is kindness, No. 54 mindfulness, No. 59 openness, No. 79 silence — that can be tools for managing pain.
“Pain is a teacher,” Shapiro says. “When pain comes, you can say, ‘Oh, school is in session, I have to cultivate a healing quality,’ to turn the tables on pain and make it work for you.”
For the book’s 2010 edition, Shapiro baldly shares his own deep pain. His beloved older sister fell as a baby and suffered a grave brain injury, and his family struggled with the consequences until and after her death at age 27.
Shapiro went on a spirit quest, left Judaism, even left medicine for a while. He was about to re-enter with a job at the Mayo Clinic when he jumped to a residency at a New York City facility practicing community psychiatry in the streets, where Shapiro saw the most pain and suffering.
Eventually, he came west and in the 1980s was medical director of Oregon State Hospital, and in the 1990s medical director and staff psychiatrist for Columbia Community Mental Health in St. Helens.
He’s been at 12th Avenue Recovery since 1999. Shapiro says he witnesses how his clients find strength in the mind’s power. But it also is the nature of his practice that far more often, overwhelming stresses or emotions arise and swamp a client, again.
“That’s when we talk about changing the brain grooves,” Shapiro says, “and that people in recovery have to think of themselves as athletes, and they need to train.”
Shapiro emphasizes that the goal of his practice is not a cure but a shift from what he calls the spin of street-hospital-jail-street to a “float” of medication, financial support and housing. The ideal is “integration,” where a mentally ill person can recover the lost ground of life, going back to work or school.
Not many of Shapiro’s clients integrate. The brutal reality of the work is that relapse is part of recovery. Shapiro says success in his work defies conventional definition — there’s no straight input-output in mental health care, especially for his clients.
“Sometimes what we offer doesn’t match what they wanted,” Shapiro says. “I give full attention to a client, but I don’t attach myself to the outcome because they’re going to do what they’re going to do.”
Caregivers do experience chronic disappointment, and it can chew them up. To help colleagues maintain equilibrium, Shapiro wrote a Ten Commandments called Thou Shalt Not Burn Out. No. 1: “Know the illness: severe and persistent with remissions and exacerbations. This involves lifelong study and learning.”
David Cutler, medical director of Multnomah County Mental Health and Addiction Services, has worked with Shapiro for years and has urged him to write an academic version of his book, to reach professionals.
“One of the problems in psychiatry nowadays is that there’s so much pressure to prescribe drugs and do medical things instead of psychosocial things,” Cutler says. “Those things are still important, and most of us psychiatrists think of ourselves as having those skills, but Phil is one of those who actually has them.”
Shapiro’s wife of 37 years, Sharon Whitney, says, “He’s doing exactly what he needs to do and wants to do and loves to do, and he’s fulfilled. If he were in a job that kept a lid on his talent, and he has been in those positions, that’s when you get burnout.”
Erika Armsbury, who works with Shapiro as program manager of acute services at 12th Avenue Recovery, says she has seen his lasting impact, even outside the clinic.
“We’ll go do outreach, and people light up when they see him,” she says. “A lot of the times, these folks have been traumatized by doctors. But he has what I would call beautiful relationships with his clients.”
By June, Jack felt so strong that he approached Shapiro and offered to lead an occasional hour of “music appreciation” after the group sessions. Shapiro said great idea, service to others is part of healing. So every other Monday, Jack took his guitar to the Living Room.
Until December 2008, 12th Avenue Recovery was a part of Cascadia Behavioral Services. But when Cascadia underwent a financial crisis, Multnomah County authorities asked Central City Concern to take over the clinic. Ed Blackburn, Central City’s executive director, says the organization needed a long time to make a decision.
“The alternative was perhaps shutting it down,” Blackburn says. “We did have a mental health capacity, but not enough. When we figured out how we could do this, we agreed to take it over.”
Today, Central City Concern is building a $19 million, 44,000-square-foot medical facility at the corner of Broadway and West Burnside Street in Old Town. When it opens in the fall of 2011, it will accommodate the staff and many of the services of 12th Avenue Recovery, including the Living Room and Shapiro’s healing principles.
“It’s an engagement model we’re very hopeful about,” Blackburn says. “Phil already has been talking to the staff about his approach, and it’s already affected the providers and staff at Old Town, getting them talking about how you manage illness.”
Last month, I went to a few of Shapiro’s group sessions. No sign of Jack. Instead, one guy rejoiced in 320 hard-won days of clean and sober. A big man clutching a stuffed doll sipped coffee. A woman, her face full of panic, sat down, stood up, sat down, stood up, sat down, stood up, then fled. A shaggy man stood outside the windows and bellowed.
After group one day, a few people stayed behind to play bingo. Shapiro headed to his office for appointments. I left the clinic, turned south on 12th Avenue and went about six paces when I saw him, and he saw me.
He walked heavily, body trembling, hair askew, clothes dirty, hands swollen, face red and bloated. Jack stopped, then wailed, “I lost my apartment.”
Then, quietly, “I’m on a bender.”
Offered a cup of coffee, he slowly shook his head. Then he shuffled away to the corner with Stark Street, past the door to the clinic where inside, in a room for healing with soft sofas and doughnuts, a woman asked the guy playing the piano to keep it down, and she called out numbers for bingo.