My experiences working in a psychiatric hospital and undergoing my own traumas early in my life lead me to agree with Sera Davidow’s observations about the mainstream mental-health system [“An Open Mind,” interview by Tracy Frisch, April 2017]. Traditional treatment teams often act arbitrarily and seldom involve the patient in making decisions; clinicians rarely share information about their own lives; and in-depth discussions and community are largely absent.

Davidow’s push for alternatives to mainstream psychiatric care should gather a lot of steam over the next few years. Her Recovery Learning Community in Massachusetts gave me hope that other states, including my own, will adopt a similar program. It’s a great model for helping those with mental illness.

Saundra J. Raynor
Olympia, Washington

The interview with Sera Davidow was painful to read. My transgender son attempted suicide on several occasions many years ago. He’s doing well now, but it was a difficult time for us. I remember being frustrated by the lack of mental-health treatment options available to him. I wish Davidow’s organization had been around back then. I’m thankful it’s there to help others now, and to remind us that, on some level, we’re all responsible for each other.

Name Withheld

As a psychiatric nurse for the last thirty years, I found many valuable insights in the Sera Davidow interview. Most people working in mental health are extraordinarily sensitive and caring, but mountains of paperwork, cuts in funding, and closures of treatment facilities challenge our ability to maintain compassion for those in our care.

Many psychiatric medications are overused, and the side effects can be miserable. But, like antibiotics, they can be lifesaving. A family member of mine suffered mood swings for a decade, from intense mania to near-catatonic depression. Now, after more than thirty years on lithium, my loved one has healthy kidney function, an intact family, and a satisfying career. I am grateful for the beautiful mystery of life, and for lithium carbonate.

Abigail Cobb
Yellow Springs, Ohio

I am bipolar with attention deficit hyperactivity disorder, and I found Tracy Frisch’s interview with Sera Davidow thought provoking. As a forty-year-old white woman from an upper-middle-class background, I have access to good mental healthcare. Not everyone is so fortunate, especially women of color and immigrants who may not speak English. I agree that the U.S. falls short in providing sufficient mental-health services to its citizens.

I disagree, however, with Davidow’s claim that medication helps only about 20 percent of the population. What research is she quoting? My medications keep me alive, functioning, and contributing to society. Acupuncture and herbal remedies are not good alternatives for treating serious mental illnesses like schizophrenia and bipolar disorder. A lot is wrong with the pharmaceutical industry, but I’m grateful for my medications and plan to keep taking them.

Lisa Kreutter
Winter Park, Florida

I respect Sera Davidow for the brave, openhearted work she does, but I’m frustrated with her antiscientific positions. Much is wrong with the modern mental-health system — from the self-serving research industry, to over-medicalization, to the callous treatment of the vulnerable — but abundant hard evidence now shows that many people with mental illnesses have structurally and functionally different brains.

It’s irresponsible for Davidow to say, “It’s hard to take a drug like lithium for very long without it destroying your kidneys.” People on lithium do need to be medically monitored, and a small percentage will develop reduced kidney function over decades, but 20 percent of people with bipolar disorder will die by suicide, and more than twice that number will attempt it. Lithium can prevent these losses. Similarly, attributing the premature mortality of people with mental illness to the medications used to help them is like saying people with cancer die because they receive chemotherapy. Yes, medical treatment of serious conditions carries its own risks, but linking most of the bad outcomes to the treatment is neither true nor helpful.

Tesi Kohlenberg
Watertown, Massachusetts

Having been in the mental-health system both as a patient and an employee, I agree with much of what Sera Davidow described. Medication, for instance, helped me initially, but taken year after year it damaged me. When I developed facial tics, I asked my psychiatrist about stopping. She said, “Would you rather have a facial tic or be crazy?” I let her answer sway me for a while, but eventually, with the help of my partner and the website The Icarus Project, I stopped taking my medications.

In other places, however, Davidow presents too black-and-white a picture. Psychiatry is not a monster trying to control meek and innocent victims. She describes big men standing over patients, but I never witnessed that. In fact, as a five-foot-two staff member at a mental hospital, I sometimes helped restrain patients, and I’ve also been restrained myself. It’s difficult regardless of who inflicts it on you — two women, in my case — yet knowing others were in control was somehow comforting to me.

When Davidow admitted to engaging in cutting, she lost all credibility for me. Self-harm is not coping. I, too, used to engage in cutting, and I am grateful that people in my life gave me a choice: either them or the razor blade. I chose them — which, really, was choosing myself.

Kathy Carr
Brattleboro, Vermont

Sera Davidow responds:

To Saundra J. Raynor: Though I feel validated to hear about your difficult experiences, I’m saddened all the same. It’s well past time for change.

To Name Withheld: I’m sorry to learn of your son’s struggles but glad things have shifted in recent years. I’m personally aware of many transgender people who have attempted suicide. Society too often fails to meet people’s basic needs for connection and acceptance.

To Abigail Cobb: I’m pleased you highlighted the issue of paperwork, which prevents well-intentioned folks from being human with one another. I’m also glad your family member recovered by using what I imagine are a number of methods, including psychiatric drugs. Many people credit these drugs with helping them lead successful lives. The key here is informed consent, which, in spite of being a legal requirement, isn’t always obtained. My goal is not to limit people’s access to any treatment but to ensure they know all the paths available.

To Lisa Kreutter: I’m not saying you aren’t part of that 20 percent who benefit from psychiatric drugs, but I know people who have been helped by spiritual practice, acupuncture, joining a roller-derby team, and so on — both with and without drugs.

To Tesi Kohlenberg: That the brain is involved in depression is no surprise, but showing differences in scans of “depressed” brains, for example, is not the same as identifying a cause or a path for improvement; differences can also be observed in the scans of people who are listening to music, who are taxi drivers, or who are in love. Also brain-scan studies do not always factor in the impact of psychiatric drugs, which can change one’s brain. I fear you underestimate the drugs’ risks. I’ve met people in their early twenties who are on dialysis due to lithium. People deserve to know the reality of these risks before choosing for themselves.

To Kathy Carr: My organization works in a number of hospitals; when I refer to large men looming in anticipation of restraint, it’s not fantasy. It’s what we’ve seen. I’m sorry I lost credibility for you when I acknowledged my use of self-injury. The people who have judged me for it, deemed me a danger to myself, or tried to make me stop were not the ones who helped me. Many people use some form of self-injury to cope: overeating, binge drinking, and so on. These practices are more socially acceptable, but acceptability depends on what the majority of people understand and are comfortable around. Seeking to understand self-injury is better than dismissing or condemning it.

Greg Ames’s writing is raw and, at the same time, eloquent. I read his short story “Hallie Bang” [April 2017] four times.

Julie Bess
Bloomington, Indiana

I can read only a few pages of your magazine before becoming so emotionally overcome I have to lay it aside until I can venture into it again. The Sun often gives me a glimpse of the better part of myself. The April 2017 issue’s poetry was outstanding, but it was David Rutschman’s story “The Donkey at the Gates of the Kingdom of Heaven,” read during a quiet lunch in my employee break room, that caused me to burst into tears in front of my coworkers.

Paul Smethers
Nashville, Tennessee

David Rutschman’s “The Donkey at the Gates of the Kingdom of Heaven” is one of the most beautiful things I have ever read.

Abigail Hagler
Craftsbury, Vermont

OK, we’re all going to want the lima-bean-soup recipe that Sparrow refers to in his April 2017 contributor’s note. Give it up.

Kali M. Kaliche
Williams, Arizona

Sparrow responds:

1927 Lima-Bean Soup

1 cup dry lima beans
½ cup cooked rice
1 medium carrot, sliced
5 plum tomatoes, sliced
2 bay leaves
¾ teaspoon basil
¼ teaspoon white pepper
Dash of paprika
¼ teaspoon sea salt

Soak lima beans overnight. Wash, then place in a pot of water and heat. When beans boil, skim off foam. Add tomatoes and spices. Simmer for 1 ½ hours. Add carrots. Continue to simmer for at least an hour. (You want the lima beans to dissolve into liquid.) Add rice and serve.

Note: I call this “1927 Lima-Bean Soup” because I’m trying to re-create the Jewish soups of my father’s youth. (He was born in 1919.) My meditation group avoids onions and garlic, which is why they’re absent from this recipe. My father’s kitchen happens to have white pepper, so I use it. I prefer this soup a little spicier, but my father dislikes cayenne. Also he is opposed to any vegetables besides carrots.