THERAPY: Seeking Cures, but Finding Anguish

Los Angeles Times

 

THERAPY: Seeking Cures, but Finding Anguish
By Carol Mithers

Last week, Connell Watkins, an unlicensed Evergreen, Colo., “therapist,” and her assistant Julie Ponder were convicted of reckless child abuse in the death of 10-year-old Candace Newmaker, who died of asphyxiation during a “rebirthing” session. Now that the two women face up to 48 years in prison, now that the nation has expressed its outrage at the radical therapy that led to the tragedy and Colorado Gov. Bill Owens has signed “Candace’s Law” banning rebirthing in his state, the temptation is to sit back, breathing a sigh of relief that justice has been done and a horror like this won’t happen again.

But it will.

As an example of therapy run amok, this incident involving a little girl wrapped tightly in a blanket, choking on her own vomit and vainly pleading for her life, was particularly grotesque, the stuff of nightmares. But it was far from unique.

For at least 30 years, stories of patients pursuing experimental treatments with similarly tragic outcomes to that of Candace and her mother, Jeane Newmaker, have surfaced at regular intervals. They all have at their center deeply troubled souls hungry not for help but cures, and programs that promised to provide them. In the 1970s, it was Synanon and the Center for Feeling Therapy, a Los Angeles program run by mostly unlicensed therapists who beat, abused, controlled and financially exploited 350 long-term patients, leaving their lives a shambles. A similar group, the Sullivanians, flourished in New York City.

The 1980s brought therapies for now widely discredited diagnoses of “recovered memory” and “multiple personality” disorders, which some therapists proclaimed the true cause of problems that ranged from depression to sexual dysfunction to obesity. In one typical case, a Des Moines woman who sought help for depression had her life ruined by a Chicago psychiatrist who encouraged her to believe she had 300 personalities, had participated in a satanic cult that plotted to kill her children, and that her father had ground human remains into hamburger for meatloaf. (Several hospitalizations and two suicide attempts later, she accepted a $10.6-million malpractice settlement.)

The ’90s brought treatment for “reactive attachment disorder,” a syndrome in which a deprived or abused child–like Candace–has difficulty forming intimate bonds. (The disorder remains controversial, because there’s no consensus on the uncertainty of the diagnosis.) The kind of rebirthing process Candace went through was just one of the experimental therapies devised to cure it; another was “rage reduction therapy,” a rough restraint of children intended to help them understand their emotional estrangement. It, too, led to excesses: A Utah 3-year-old died after her father attempted to apply the techniques, and a Tarrant County, Texas, practitioner was ordered to pay $8.4 million to a 15-year-old girl his treatment left covered with bruises. As early as 1998, Colorado medical examiners had accused psychiatrist Foster Cline, who pioneered the therapy, of grossly negligent practices.

Why do otherwise intelligent and well-meaning people embrace treatments that, in retrospect, seem so clearly mad? Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, points to desperation, tremendous guilt on the part of parents “when there’s something wrong with their child that they can’t fix.” But there’s another factor at work, too: widespread, unreasonable assumptions about what therapy should be and can do.

Nearly 50 years ago, humanist psychologists like Erik Erikson, Rollo May, Abraham Maslow and Carl Rogers challenged traditional Freudian claims that to be human was to be filled with inner conflict. Nor did they accept that the best analysis could do was help a patient understand and cope. Instead, they said, the natural state of humans is one of wholeness and joy, and treatment should aim to help everyone realize his or her full “potential.”

By the 1960s, when economic prosperity made room for more self- indulgent pursuits like examining one’s inner self, therapy, once drawn-out, exclusive and expensive, reached the masses in the form of encounter groups. The groups were frequently harsh and combative, and pushed the idea that change came fast.

By 1970, Arthur Janov, founder of “primal therapy” (made wildly popular by Beatle John Lennon), went one step further, flatly declaring that all neurosis came from infant trauma and that his therapy, which specialized in overnight transformation, could cure it.

Most ’60s and ’70s therapy programs didn’t last. But they left deep and permanent changes in the way we view our lives (we are entitled to be fulfilled and happy), our problems (they have specific, simple, diagnosable roots) and, above all, the practice and role of therapy. We now turn to therapists, whether as self- help authors, commentators or actual practitioners, for advice that in earlier times would have come from clergy, parents and community. We expect therapy to be dramatically transformative, with frequent, climactic “breakthroughs” (an expectation encouraged by the culture of advertising, which tells us that anything from makeup to a new car can turn us into a new person). We accept that it may be harsh– an acceptance, notes Caplan, that taps into fundamentalist American beliefs that suffering is redemptive. Above all, we expect it to provide a “cure.”

Although ethical, well-trained therapists refuse to go along with these beliefs, those who are less moral or more driven by their own convictions are happy to indulge. And the media, particularly talk shows, with their insatiable appetite for guests to fill airtime, help by parading every new guru who comes along, often without bothering to check out his or her credentials or the theory’s validity.

But while the pain that drives people to seek treatment is often deep and legitimate, the sad reality of life is that many problems have a complicated stew of causes and no definitive cures. A marriage can go pale and sour because of the family histories of each spouse, their gender beliefs, their feelings about themselves, their pleasure or disappointment in their individual lives. An intensive therapeutic weekend aimed at “teaching intimacy” can’t necessarily bring it back to life. Making peace with one’s inner child won’t guarantee weight loss in a sedentary, fast-food society. The despair of a man or woman stuck with a low-wage job and bad child-care options can’t be counseled away. And poor Candace, whose childhood was marked by poverty, constant moves and multigenerational family dysfunction, whose birth mother twice lost custody to social workers and who Candace said once dropped her out a second-story window, may not ever have become the well-adjusted, affectionate girl that Jeane Newmaker so craved.

Sometimes, good therapy can help us understand, face and tame our demons. Sometimes, it can greatly improve our lives. But neither it nor anything else can prevent life from being hard and unfair. It can’t guarantee happiness. It can’t guarantee cure. These are the hard lessons of adulthood, and there’s no sign that we as a culture have learned them. The next therapeutic tragedy is out there, waiting.

The Veterinarian Brings His Healing Presence to Pets of the Unhoused

 

 

The man standing outside the tent on Skid Row in downtown Los Angeles clearly doesn’t live in the neighborhood. Tall and fit, he’s dressed in jeans and a doctor’s blue scrub shirt and carries a medical bag. The tent, one of many rough structures on the stained sidewalk, sits amid heaped wooden pallets, old furniture and trash. But the man’s eyes are fixed on the dog lounging nearby.

“Hi, how are you?” he says when the tent flap opens. “I’m a veterinarian, Dr. Kwane Stewart, and I offer free pet care to people experiencing homelessness.” He gestures at the dog. “Can I examine your pet?” 

First comes confused silence—you’re who?—then suspicion: Is this animal control, here to take my dog? Finally, a slow nod. Stewart, who calls himself the Street Vet, kneels, pulls out his stethoscope and goes to work.

These Skid Row streets hold the nation’s largest concentration of homeless people who are not staying in a shelter, and at first glance it’s an unrelieved landscape of despair: mental illness, poverty, addiction. But love exists, too, including the love of pets. Across the nation, 10 to 25 percent of the people who are homeless keep pets, and there’s no reason to think the number is lower in sunny Los Angeles. Cats sit on sleeping bags, pit bulls, scruffy terriers and mutts trot alongside filled shopping carts, and chihuahuas ride in bicycle baskets and the laps of people who themselves are in wheelchairs. Various local groups and volunteers help the owners of these animals care for them, with weekly and monthly clinics, mobile spay and neuter vans, handouts of flea meds and food. 

Stewart, 50, has usually worked solo, walking the streets and looking for animals and people in need. “Maybe it’s because when I began this work, it wasn’t uncommon to find a pet that had never received care,” he says. “Everyone I met looked at me as if I’d just dropped out of the sky.”

Stewart grew up with dogs, loved them and science, and by the time he was 10 knew he would become a veterinarian. It was an unusual ambition for a Black track star in Albuquerque. Once, a coach asked about his future plans and laughed with disbelief when Kwane told him. “I’ve never met a Black vet,” the coach said. Stewart goes on, “At the time I didn’t think much about it. But here’s the thing: He was Black himself.” Decades later the number of African American veterinarians is still so small the Bureau of Labor Statistics has reported that it might as well be zero. 

Stewart graduated from the University of New Mexico, got his DVM degree from Colorado State University College of Veterinary Medicine and Biomedical Sciences, and headed to San Diego. He spent a decade there treating a suburban clientele with “bottomless bank accounts.” Then, in 2008, he relocated to Modesto, in California’s Central Valley, for a job as the veterinarian for Stanislaus County. And everything changed. 

The Great Recession flattened Modesto, a city of around 200,000, with plummeting home prices and 17 percent unemployment. And when humans go broke, animals often pay the price. Pet surrenders surged until the area’s aging shelter, built for 200 animals, held twice as many, and its euthanasia rate became one of the nation’s highest.

“I was destroying 30 to 50 animals every morning,” Stewart says softly. “Healthy dogs and cats. It was killing my soul. I felt like God was keeping score and I was losing. I didn’t go to school all those years to destroy animals. I wanted to help and save them.”

At first that meant he helped a homeless man he encountered almost daily by treating the man’s dog, which suffered from a bad flea bite allergy. Then he held a free clinic at a local soup kitchen. And then, on his own time, he began to walk around Modesto and some Bay Area sites looking for pets to help. He moved to Los Angeles to serve as chief veterinary officer for the American Humane Association, which makes sure animals are treated well on film sets, and his ramblings shifted to San Diego and Los Angeles. He wore scrubs to identify himself, carried a bag filled with meds, vaccines and syringes, nail trimmers, and he did what he could, free of charge. 

He was stunned by what he found. Like many people, he questioned why homeless people had animals to begin with—if humans couldn’t take care of themselves, how could they be responsible for pets? And yet they were. In fact, numerous academic studies over the years have revealed the vital role pets play in the lives of unhoused men and women—providing structure, purpose, meaning and love. “Researchers have consistently found very high levels of attachments to pets among the homeless,” Leslie Irvine, a sociologist, writes in her 2012 book about the phenomenon, My Dog Always Eats First.

Stewart agrees. “Pets were a lifeline to the people I met,” he says. “Most of them were great pet owners. They did remarkably well with the resources they had, and made sacrifices for them well beyond what you or I would. The bond between them was on a completely different level. They needed each other.”

 

For five years, his efforts were a kind of secret hobby that he says even his family—he has three children—didn’t know about. Then, in 2017, he and his brother, Ian, produced “The Street Vet” as a reality TV series­—it has aired on broadcast TV in Scandinavia and Eastern Europe and in the States on a Utah cable channel­—and Stewart acknowledges he’s now a “media personality.” These days he’s founding a new veterinary practice in San Diego and writing a book about his experiences on the street.

Last September he started a nonprofit, Project StreetVet, raising money on GoFundMe to cover the cost of treating pet medical problems beyond the scope of a sidewalk exam. He has occasionally volunteered with larger organizations assisting people who are homeless. Though he says “there are probably more efficient ways I could spend my time,” he likes doing it his way. 

“The wound is healing well,” he reassures a man named Ben, whose pet rat had been attacked by a cat. (“I’ve seen birds and snakes, but this was my first rat.”)

“The puppies look great,” he tells Julian, a tattooed man who has lived on the same stretch of pavement for two years and whose dog recently gave birth. (He also vaccinates the pups.) 

Stewart marvels at the generosity of a young man named Reggie, who lives in a school bus and uses his own cash to make lemonade that he gives away to his neighbors. Stewart vaccinates the man’s dog, Daisy. “You’re doing a good job,” Stewart says.

“Oh, this is such a blessing,” the young man replies. 

Most Americans Have Pets. Almost One Third Can’t Afford Their Vet Care

Since mid-2020, more than a thousand low-income families have brought their sick and suffering pets to the nonprofit Pet Support Space, housed in a tiny Los Angeles storefront. One 14-year-old dog had a tumor that a veterinarian had quoted $5,000 to remove. A four-year-old pit bull had been vomiting for days, a cat’s painful bladder stones required surgery, a pug limped from the foxtail embedded in its paw. Skin and ear infections abounded. Neither the animals’ problems nor their owners’ inability to afford help for them was a surprise.

recent nationwide study found almost 28 percent of households with pets experienced barriers to veterinary care, with finances being the most common reason. In low-income households, the researchers found, financial and housing insecurity can increase the risks that animals will not receive the care they need. Sociologist Arnold Arluke, author of Underdogs: Pets, People and Poverty estimates that 66 percent of pets in poverty have never seen a vet at all.

The “why” behind those numbers is complex. Of course, money is the primary problem. Veterinary care is expensive. A majority of practitioners work in for-profit clinics, consolidation in the industry has increased emphasis on profit margins, and vet prices have risen faster than the overall rate of inflation. That has checkups starting at $50, dental cleaning going for $70-$400, and blood work and x-rays at $80-$250. If a dog breaks a leg or eats a sock, surgery costs begin at four figures.

High prices aren’t necessarily about greed. Michael Blackwell, a former Deputy Director of the Center for Veterinary Medicine at the FDA, is the chair of the Access to Veterinary Care Coalition (AVCC) that was formed in 2016 to study this very problem. Veterinary training, he said, teaches vets to practice a “gold standard” of care, which means running every possible diagnostic test and pursuing every treatment option, even when a client’s budget is limited. (Many pet owners don’t know they can decline a recommended procedure, such as blood work, and even fewer are willing to decline care for fear of looking heartless.)

Some private vets offer struggling clients discounts, added Jeremy Prupas, DVM, Chief Veterinarian for the City of Los Angeles, but they themselves carry an average of $150,000 in student loan debt, so they simply “can’t carry the immense existing need on their own.” Telling clients you can’t help them because they have no money is one of the leading causes of burnout in the veterinary profession, according to Prupas. Pet insurance might help defray costs but requires monthly premiums and comes with such a complicated array of deductibles, co-pays, caps, and exclusions that one how-to guide recommends hiring an attorney to review the policy. Credit cards designed for medical care financing, if one can qualify, can carry punishing interest rates as high as 26.99 percent.

Equally critical is a long-term failure on the part of the animal welfare movement to consider, much less prioritize, the needs of low-income pet owners. Since the 1990s, the rescue/humane world has poured vast amounts of funding and energy into cutting shelter euthanasia through adoption, but far less into helping those without money take care of the pets they have. “If you can’t afford an animal,” the thinking went, “then you shouldn’t have one.”

“Until recently, we focused on shelter-centric challenges,” acknowledged Amanda Arrington, senior director of the Humane Society of the United States’s Pets for Life Program, which assists low-income pet owners. “There was a lot of judgment and making determinations on who was or wasn’t deserving of support and resources that was influenced by what I think a lot of society is influenced by, which is classism and racism. We conflated a lack of financial means and access with how much someone loves their pet or desires to care for it.”

In fact, owners can be punished because they can’t afford veterinary care — “most humane neglect cases stem from an inability to get care for a pet,” said Prupas. In Michigan, for example, failing to provide an animal with adequate care, including medical attention, is a misdemeanor that can carry 93 days in jail and/or a fine of up to $1,000. With a second violation, it becomes a felony.

The distorted belief that ‘those people’ don’t care about their pets has never been true.

What exists for pet owners in poverty is a patchwork of low-cost care options, ranging from local efforts — such as Emancipet in Texas and the Philadelphia Animal Welfare Society — to well-funded national enterprises such as Pets for Life, which operates in several dozen cities. The great majority, however, offer only basic services like sterilization, vaccination, and flea treatments. “We are not a full-service veterinary clinic and do not treat sick or injured pets,” warns one low-cost option on its website. Another suggests that needy people travel, since “vets in smaller towns may charge lower fees,” or start a GoFundMe. As a result, many types of care are largely unavailable: emergency care (by some estimates one in three pets will have an emergency need each year), management of chronic conditions such as diabetes or kidney disease, medication, dental care (dental disease affects perhaps 80 percent of older dogs), and the mercy of humane euthanasia (which can run $50-$300).

The final piece of the care gap is a practical and cultural disconnect. Because many economically challenged neighborhoods are “vet deserts,” with few if any practitioners, it’s not easy to find care, and reaching it can require wrangling an unhappy animal over distance and/or arranging private transportation. Keeping an appointment at an office with weekday-only business hours or a once a month clinic can mean losing a day’s pay. Paperwork raises the fear of immigration status inquiries. The veterinary profession also remains one of the country’s whitest: Just as people who feel alienated or unwelcome don’t utilize human health care options, pointed out Arluke, they don’t utilize care for their pets.

The result has been suffering: most directly for animals that remain untreated, die from what vets call “economic euthanasia” (putting an animal down because treatment costs too much), or end up in shelters. Fear of a looming vet bill, and the mistaken belief that all shelter animals receive medical care, is a prime cause of owner surrender.

But people pay, too.

Some sick animals can infect their humans. Roundworms, for example, can pass through contact with pet feces and cause lung, heart, and eye problems. Blackwell reports meeting an optometrist who practices in a low-income Florida community who has seen increasing numbers of children with roundworm larvae in their eyes.

The psychic toll is just as real. Families in poverty who love their pets and for whom “they offer an emotional core and possibly one of the only sources of joy” face “mental and emotional” devastation from the unimaginable choice of weighing that love against potential financial ruin, said Blackwell. Professor Katja M. Guenther, author of The Lives and Deaths of Shelter Animals, called the rupture of an animal-human bond “a kind of community violence” in a 2021 webinar.

Change seems increasingly possible. Covid-19 and the country’s recent racial and economic reckoning has prompted humane organizations to examine their assumptions and biases about who has the “right” to a pet’s love, and, said Arrington, there’s increasing recognition that “racial and economic injustice really impacts animal welfare.” Meanwhile, AlignCare, a new program out of Michael Blackwell’s Program for Pet Health Equity, is trying to create a national model of something like Medicaid for domestic animals. Under the program, families already found to be struggling (because they participate in SNAP or a similar program) and who ask for help at a shelter or veterinary clinic will be signed up and paired with a veterinary social worker or support coordinator. They’ll then be directed to a veterinarian who has agreed to offer preventative, dental, and even critical care, for a reduced fee; AlignCare will pay 80 percent of the cost. After three years of pilot programs in 10 disparate communities, it’s taking on its biggest challenge yet, Los Angeles, where one in five people live in poverty.

AlignCare won’t offer “gold standard” care, instead emphasizing preventative, incremental, and cost-saving measures (such as offering telehealth appointments and limiting diagnostics that won’t change treatment options) when possible. But it will expand the human safety net to include the animals most of us now consider part of our families. And while the effort is currently funded by grants from Maddie’s Fund, the Duffield Foundation, and Petsmart Charities, Blackwell’s goal is “community ownership:” The combined involvement of local vets, city animal services departments, social service agencies, rescue and community organizations, pet food and product manufacturers, and affluent pet owner-donors can make the model self-sustaining.

There is no perfect solution for low-income pet owners who need help accessing veterinary care. But growing awareness of the problem is a big step forward. “What we call ‘animal welfare’ is changing,” said Lori Weise, whose nonprofit, Downtown Dog Rescue, runs the Pet Support Space. “The distorted belief that ‘those people’ don’t care about their pets has never been true. People can’t afford care. Sometimes they don’t even know what’s out there; they themselves have never been in a hospital. As more people are brought into the system, we’ll see the first generation to get proper veterinary care.”

 

[/vc_column_text][/vc_column][/vc_row]