By William Jiang, MLS
Happily, I step out of the quick-moving steel elevator in my gym clothes after working out for an hour in the basement of the modern architectural beauty that is the hospital in which I work. I always like passing the entrance at 1051 Riverside Drive. Known as the Atrium, this artistic masterwork looks like a web woven with intricate white girders that support the giant glass facade. I reach my floor and I take two quick rights. The hallway lights flicker a bright institutional white. It is early in the morning as I take out my keys to open the three sturdy steel doors behind which is my library. It is a rare kind of library in, arguably, America’s oldest and most competitive psychiatric research institution. I have reached The Patient and Family Library of New York State Psychiatric Institute (NYSPI), and I am its Chief Librarian. I open the last white steel door to my library and it closes behind me. I am excited because the online book catalog that I programmed from scratch is live and is searchable from anywhere in the world. This includes the three adult inpatient units in our hospital, and those are the most important people I want to reach. Those are the people I want to reach with our collection of psychoeducational bibliotherapeutic books, magazines, DVDs, and ready-reference materials in English and Spanish. In other words, my library offered educational materials about various mental disorders to help the sufferers cope better and develop insight to their challenges brought about by their illnesses.
This was a typical day for me at NYSPI. I was the Chief for seven years between July 2004 and July 2011. In that time I learned a lot about the major mental illnesses that NYSPI treats: eating disorders, anxiety, depression, bipolar disorder, and schizophrenia. These mental illnesses are significant and touch everybody in our society. Even if you don’t have a mental illness yourself, there is definitely somebody that you know or have passed by during your day who is personally affected. According to the Surgeon General, one in four Americans suffer from one or more of the disorders I listed above. Mental illness does not discriminate, and it can strike anybody: the homeless man in the street or the wealthy “do-ers” of American society.
There was a delegation from Korea that came to study my library as a model for Korean psychoeducational libraries. There were also four other patient libraries in the United States that came to me to help them build successful patient libraries based on the concept of psychoeducation. My library helped over 1,000 per year. In terms of the physical collection, my library had the following resources: over 500 books that were specially selected by staff and myself geared towards laypeople but that gave education and insight to our patients. We had books that dealt with topics from theoretical to concrete psychology. One could find a book about Freud and Jung or 100 Questions & Answers About Schizophrenia or The Mindful Way Through Depression. Also the library had periodical subscriptions to 12 psychoeducational magazine and newsletter titles. We had everything from Scientific American: Mind to ADDitude. Also, the library had over 100 psychoeducational video titles from MTV’s True Life: I Have Schizophrenia to NOVA’s documentary about eating disorders: Dying to Be Thin. I also got the best available psychoeducational ready reference materials from the National Institute of Mental Health. These took the form of pamphlets that were attractive and easily given to people who needed a quick comprehensive introduction to a particular disorder. It could have as easily have been someone who wanted to learn about bipolar disorder in Spanish or maybe they wanted a mental health crisis and resource referral line in New York City in Chinese such as LIFENET.
I remember that my Patient Library had a movie event and panel discussion about brain stimulation techniques organized around the amazingly insightful movie “Shock” that featured the struggle with the dark depression of the wife of the presidential candidate Michael Dukakis: Kitty Dukakis. She came forward to fight the stigma associated with mental illness by letting the world know in this movie that she needed needed electroshock therapy otherwise known as electroconvulsive therapy (ECT) to deal with her severe depression. The movie had people who were pro and con ECT, so it felt balanced. It is sobering to think that sometimes, the only thing standing between certain death and you is that man in a white coat with his hand on the healing power of electric current: the psychiatrist. that being said, I personally would undergo ECT based on what I know about its efficacy and possible adverse effects.
The result of much of the learning that I attained as Chief Librarian is published in two works of nonfiction. I shared some of my objective knowledge about psychiatry in The Medical Librarian's Guide to Anxiety, Depression, Bipolar, and Schizophrenia: Nutrition,and Complimentary Therapies, Createspace, 2012. The book covers a lot of ground, and is potentially useful for many. For example, omega-3 fish oils have the power to prevent fully- blown psychosis in those that are prone to it due to genetics and/or environmental factors. Amazing stuff! My second work of nonfiction is my autobiographical sketch: A Schizophrenic Will: A Story Of Madness, A Story Of Hope which I wrote to do my part to combat the stigma surrounding mental illnesses and to give people living with my same diagnosis hope. It also qualifies as a psychoeducational text.
I have mentioned psychoeducation, but what is it really?
Psychoeducation
Psychoeducation refers to the education offered to people who live with a psychological disturbance. Frequently psychoeducational training involves patients with schizophrenia, clinical depression, anxiety disorders, psychotic illnesses, eating disorders, and personality disorders, as well as patient training courses in the context of the treatment of physical illnesses. Family members are also included. A goal is for the patient to understand and be better able to deal with the presented illness. Also, the patient's own strengths, resources and coping skills are reinforced, in order to avoid relapse and contribute to their own health and wellness on a long-term basis. The theory is, with better knowledge the patient has of their illness, the better the patient can live with their condition.
The concept of psychoeducation was first noted in the medical literature, in an article by John E. Donley "Psychotherapy and re-education" in The Journal of Abnormal Psychology, published in 1911. It wasn't until 30 years later that the first use of the word psychoeducation appeared in the medical literature in title of the book The Psychoeducational Clinic by Brian E. Tomlinson. New York, NY, US: MacMillan Co. This book was published in 1941. In French, the first instance of the term psychoéducation is in the thesis "La stabilité du comportement" published in 1962.
The popularization and development of the term psychoeducation into its current form is widely attributed to the American researcher C.M. Anderson in 1980 in the context of the treatment of schizophrenia. Her research concentrated on educating relatives concerning the symptoms and the process of the schizophrenia. Also, her research focused on the stabilization of social authority and on the improvement in handling of the family members among themselves. Finally, C.M. Anderson's research included more effective stress management techniques. Psychoeducation in behavior therapy has its origin in the patient's relearning of emotional and social skills. In the last few years increasingly systematic group programs have been developed, in order to make the knowledge more understandable to patients and their families.
Also, my library offered bibliotherapy. What exactly is that?
Bibliotherapy
My library offered a form of bibliotherapy which has its roots in the early 19th century and before: this form of therapy is an ancient concept when we talk about libraries. The ancient Greeks put great faith in the power of literature, and a sign above an ancient Greek library read: "healing place for the soul".
In America of 1802, although the term “bibliotherapy” had not been coined, Doctor Benjamin Rush recommended the establishment of a library in every hospital to amuse and instruct the patients. Rush recommended that books be used for treatment and exhorted the medical community to hire trained professionals to work with asylum patients. However, because novels, in the early 19th century, were thought to add to the development of mental illnesses such as dementia praecox, or schizophrenia, he suggested the use of nonfiction books for the insane.
In the US the first patient library opened at the Massachusetts General Hospital in 1844. This library started by providing moral and religious reading materials to patients as they exited the hospital, back into the community. Of note, interlibrary loan from nearby public libraries existed to provide books and other materials such as business, technical, Braille, and other materials in foreign languages .
From 1906-1914 hospital-centered patient libraries were mostly seen in private hospitals, state run mental hospitals, and long-term care facilities. World War I created a huge push for more books. Books provided solace to many soldiers while they were recuperating in the US and France. The war built momentum speaking to the therapeutic power of books.
More on my tenure at NYSPI
I led psychoeducational groups on all three of the adult inpatient units in English and Spanish, and in some groups I presented my patient library newsletter that was sent around the community to over 1000 Columbia University people. Many of the patients found the groups helpful. Many issues of the newsletter dealt with things that can help people who suffer from mental illness cope with their illnesses such as meditation, breathwork, avoiding cannabis to avoid increasing the risk of psychosis, and the benefits of omega-3 fatty acids for multiple psychiatric issues. In one issue that I remember well, I included a book review of my own critically acclaimed autobiography which is available on the Kindle as well as Amazon.com in book form: A Schizophrenic Will: A Story of Madness, A Story of Hope. When I led groups anywhere in the hospital, on the English-speaking wards or Spanish-speaking units., it didn’t matter what the diagnoses of people on the units were, I had a lot of positive feedback from both patients and staff. People told me that my autobiography and my living example gave them hope to continue living. Those moments were some of my most gratifying times at NYSPI.
Now, due to budget cuts and my leaving the position of Patient Librarian, the library has closed. There is a huge demand for real estate in NYSPI because they try to maximize the amount of research that they’re able to do, and the Institute only has so many square feet of office and lab space on campus. I will always be grateful for the administration and staff of New York State psychiatric institution for permitting me the honor of making a difference in our patient’s lives during my tenure.
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