Nancy Burke The Kedzie Center: Bringing Psychoanalysis to the Community

The Kedzie Center: Bringing Psychoanalysis to the Community

Nancy BURKE

Carl Sandburg’s “Chicago” (1914) still sings, “so proud to be alive and coarse and strong and cunning,” but when it comes to care for the emotional well-being of its chorus, Chicago has historically turned its brawny back on those who carry the “terrible burden of destiny” on theirs. This neglect is not new, but has accelerated greatly over the past decades. Further, attention to disparities in the quantity of available treatment—for instance, the fact that Chicago’s former mayor, Rahm Emanuel, closed half of the city’s remaining community mental health centers with the sweep of a pen in 2012, or that the ratio of therapists to residents in wealthy neighborhoods is more than twenty times higher than that in low-income ones (Quinn, 2018)—has been accompanied by, and has often obscured, an interlocking issue regarding the quality of the therapeutic resources provided. Yet disparities in the quality of treatment should be equally obvious; those without means more often encounter longer wait times for—and little to no choice in—therapist assignment, intermittent sessions, frequent therapist turnover, and short-term, symptom-focused interventions provided by overworked, poorly-paid staff. In Chicago, psychotherapy is least available to those who need it most and least substantive, and although the same can likely be said of community services in all US cities, “in Chicago there’s been an intentional [emphasis added] disregard for investment in these areas” (Carrillo, 2018, as cited in Quinn, 2018).

Enter the game-changing Illinois Community Expanded Mental Health Services Act (https://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=3300&ChapterID=34), which went into effect in Illinois in 2012, just as existing mental health centers were being shuttered. Essentially, the Act takes mental health funding out of the hands of city and state budgeteers and places it directly into those of each affected community itself, represented by an appointed panel of Commissioners that includes neighborhood residents and individuals with lived experience. No pen-sweeps, no closures, unless the residents themselves hold the pen. It authorizes areas of Chicago to vote by referendum to delineate and tax themselves at a rate of .4% of yearly property tax, amounting to an average of $16 per household annually, for purposes of creating services that reflect their needs, cultures, and values. Support for these referenda and the centers they underwrite, now four in all (with several others in the wings), has not been equivocal. In economic hard times, these referenda have demonstrated enthusiasm rarely seen regarding other issues; in the most recent, covering the Logan Square/Avondale/Hermosa areas of Chicago’s northwest side, “[a]bout 86 percent of voters in the three neighborhoods voted in favor of opening the clinic— and nearly 80 percent voted to raise property taxes to fund it” (Bloom, 2018). (Any concern that the clinics will erode justification for or a sense of urgency around maintaining and expanding existing public clinic systems has been misplaced; there is still a desperate need for more, and the mandate of the centers created under the Act allows for the treatment of those who wouldn’t necessarily be eligible to access services at other community mental health centers for lack of a diagnosis of what is often termed “serious mental illness.”)

The implications of the Act are many, potentially affecting not only the accessibility of mental health treatment, but the nature and quality of that treatment; look no further than the first of the centers to be approved and opened, the Kedzie Center, to appreciate the transformations in mental health service delivery that the Act makes possible. It likely came as a shock to some that a small group of psychoanalytically oriented private practitioners with shared roots in community mental health, Expanded Mental Health Services of Chicago, NFP (EMHS-NFP), was chosen by the first Governing Commission to run the inaugural center. EMHS-NFP viewed itself as David to an army of Goliaths that included established hospital and other mental health systems looking to expand existing services on the basis of a stable revenue stream of approximately half a million dollars a year. What made EMHSNFP stand apart was its immersion in the life of the community and an integrated vision of healing that extends fractally from individual to family to culture and community and back. If Frieda Fromm Reichman famously stated, “to heal one person is to heal the world,” EMHSNFP added a vice versa to create a full circle of potential intervention. This vision, we are excited to announce, recently gained EMHSNFP the stewardship of another of the Actauthorized clinics, the fourth in the city, name TBA, which will open its doors in August in an area adjacent to Kedzie’s.

While many still regard community psychoanalysis as an oxymoron and view intensive psychodynamic treatment as either too costly or—even more concerning—simply inappropriate for those who struggle with material needs and significant trauma histories, EMHSNFP embraces both in-depth treatment and the modifications that make it possible to implement in the most diverse and challenged communities. These modifications do not erode the integrity of psychodynamic intervention, but rather enhance it by appreciating the nexus of internal and social cultures, both articulated and unconscious, in a way that values both and positions each as an essential interpreter of the other.1 Even further, they enable us to play a therapeutic role in fostering the well-being not only of the individual clients we treat, but of our community itself, as a hub for communal healing processes and active partnerships with schools, community centers and arts organizations. Our psychodynamic seminars and consultation for staff, efforts to address community problems through a psychoanalytic lens, and depth-oriented treatment provision “for as long as it takes” have been welcomed by all of our organizational partners, who value Kedzie precisely because of its distinctive perspective. In short, we concur with others who have found that psychoanalysis is not so fragile and rarified a method that its life-giving poetry cannot survive translation into the languages of communities in need.

Kedzie’s roots are as deep in community as they are in individual, family, and group psyches. Its offerings are hyper-local, the product of the sort of immersion that many clinicians experience in their analytic practices as they find their feet within the dream landscapes of their patients’ inner lives. The proposal for the centers was itself the product of an intermeshing of our clinical vision with prior efforts by two adjacent community organizing agencies, one of which, the Coalition to Save Our Mental Health Centers, had been exploring models for community ownership of treatment resources since its formation in 1991, fully half of 40 years spent wandering in a desert of failed attempts and broken promises until it finally gained the political traction that culminated in the passage of the Act in 2011. Along with the Coalition and the Saul Alinsky-inspired Institute for Community Empowerment, we were able to knock on a thousand doors and speak in some depth to hundreds of community members, coming to understand what need looks like from inside the bubbles of block and neighborhood as we worked to formulate our first proposal. Faith leaders, social service workers, teachers, elders, custodians, parents, principals, and physicians all had input that has, since Kedzie’s establishment, been further cultivated into an ongoing partnership.2

While Kedzie is referred to as a clinic, conjuring an image of a discrete building in physical space, its brick walls are remarkably

1. In this, we take inspiration from the landscapes and legacies of other articulations of psychoanalytic practice in community settings, including not only the innovations offered first by the Berlin Poliklinik and Vienna Ambulatorium, by SaintAlban and La Borde, but also the current iterations offered by 388 in Quebec, Greene Clinic, the Harlem Family Institute, and the New York Community Center for Psychoanalysis in New York, and a wealth of Bay Area treatment centers such as RAMS Inc. Access Institute, the West Coast Children’s Center, and Partnerships for Trauma Recovery. 2. The same efforts went into the development of our second proposal, for the about-to-be-opened clinic to serve the Logan Square/Avondale/Hermosa Chicago neighborhoods but was somewhat less immersive due to the restrictions against door-todoor interviews and on-site conversations during the pandemic.