
In Johann Hari’s exceptional book “Lost Connections” (Hari, 2018), he explores key factors that contribute to depression such as disconnection from meaningful work, other people, meaningful values, childhood trauma, status and respect, the natural world, a hopeful or secure future—as well as the role brain changes and genes play.
This being Depression Awareness Month, I find myself reflecting on how the Ranch incorporates many of these ideas into our Therapeutic Community model. Four different crews—Woods, Shop, Gardens and Farm (as well as all-Ranch activities such as haying and sugaring)—help residents reconnect with meaningful work within a like-minded community of others. Learning skills and working collaboratively supports the rediscovery of meaningful values that have previously been overwhelmed by mental health and/or addiction challenges. Residents experience unconditional positive regard which helps reinvigorate self-respect. Through their engagement in the program, residents can act as role models and leaders in the community. The work is done in a natural setting attuned to the rhythm of the seasons. Everything they do moves them forward in their goals and drives their ability to create a hopeful and secure future. On the clinical side of things, attention is paid to family systems, originating trauma, and neurological predispositions and changes.
Depression can be both a cause and a result of turning to substances or behaviors as coping mechanisms for life circumstances. In Johann Hari’s Ted Talk, “This could be why you are depressed or anxious” (TEDSummit, 2019), he asks us to think of depression as a “signal” rather than a “malfunction.” He tells a story of a psychiatrist in Cambodia trying to introduce antidepressants to Cambodian doctors. They, in turn, tell the psychiatrists a story of a rice farmer who lost his leg to a US landmine, got an artificial limb, but suffered a lot of pain from wearing the limb while working in water. He got depressed: he isolated and cried. People sat with him, validated his suffering and thought out of the box: “If we get this farmer a cow, he can become a dairy farmer.” So, they did, and he did—he came out of his home and found meaning in his life again. The Cambodian doctors told the psychiatrist they had used an antidepressant: the cow.
It may seem like a simplified case, but connected me immediately to “thinking-out-of-the-box” examples from the early years of the Ranch. SLR took many individuals who, for a variety of reasons, were depressed and had lost meaning in their life. Two examples are given in founder Wayne Sarcka’s book, Giving a Lift in Time, (Sarcka, 2007). He cites two young men who were helped by Wayne observing where these residents perked up and engaged—which Wayne then worked out how to support while in the program. This planted the seeds for meaningful work post-discharge. One resident really liked the chickens, so he learned about them, tended them at the Ranch, and then left to happily become a chicken farmer. In the other example, a resident showed interest in cows, so Wayne worked with the family to get a small herd here for the resident to learn about and tend. The resident later moved out west and became a rancher.
Some more modern “thinking-out-of-the-box” examples would be nurturing a former resident’s interest in growing mushrooms. The resident researched Shitake and Lions Mane varieties, and the Ranch supported him with finding a site, ordering supplies needed, setting it up, inoculating, and tending. It was a huge success, and that resident took away the experience of bringing an idea to fruition (and to table). Post-discharge, he became a business entrepreneur. Another resident was an accomplished woodworker and wanted to redesign all the chairs used in the dining room. He was given free reign to come up with two models which were then tested by the community. The one that was preferred became the prototype for replacing all of the old chairs.
Depression can feel like a claustrophobic cage. Very often when life is not working well (for whatever reason), removing that person from those circumstances and moving them into a supportive community helps create previously unimagined space for possibility.
Medication is very important and SLR is blessed to work with a consulting psychiatrist who collaborates with residents toward finding the lowest therapeutic dose(s) needed. Meds help take the edge off symptoms so residents can then attend to their gaps in connection through the rest of what the program offers.
As a mental health counselor, one of the main reasons I prefer to practice in this model is that I think of our community as both the vehicle and the container for healing. Within that dynamic, every single component of the SLR program is therapeutic—both in the modern sense of therapy as treatment and the ancient Greek sense of therapy as healing. The therapeutic community model provides clinicians a rich pool of context: first the snapshot and history of what came before admission (which has driven the need for treatment), then the nuances of how the resident grows and changes within the community. While in the program, the data that arises from our observation-rich environment makes resident context immediate and robust—so that we can act as responders, nurturers and supporters of a resident’s evolving/unfolding journey.
All Ranch staff engage in this to varying degrees depending on their roles, but as holders of both the large and small picture of resident experience/outcome, clinicians benefit from being able to revise and adjust perspective as needed based on what each day, week, or month brings. Patterns emerge that may at first seem trivial but are sometimes indicators of a deeper issue to be explored. Very often, these are pieces of the puzzle of why a resident has fallen off a healthy track in their lives. Behavior is noted with curiosity rather than judgment, and we work with the resident toward uncovering the driver(s) behind it. The setting at SLR yields information from many pathways, and clinicians have abundant opportunities to work alongside residents on crew, have meals, go on activities, and respond to and navigate crises in the moment. We get to see a resident as a whole person and follow the signals to uncover important information. We witness where their interest is sparked, help them learn skills/tools for coping with stressors and help guide them toward a stronger, more reliable sense of themselves in the world.