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Chapter 8
Community Mental Health Center in
Sunset Terrace, Brooklyn (1991-Present)
In 1991 I made a radical
change in my life, and
accepted a position as
psychiatrist in a community
mental health center in Sunset Terrace, Bayridge section of Brooklyn, New York.
Naturally, it has a multicultural population, but what a sedentary setting
compared with the MCU! And one with far more predictable outcomes. All but
one, that is; much to my surprise, I am working once again with a social worker
who was in the Geriatric Mental Health Program (GMHP) and the former
Director of the GMHP, who is now the Director of Social Services at Lutheran!
After the MCU, I felt so "unusual," one might say, being ensconced in
"Health Center." Some of my initial impressions of the transition were captured in
a letter I wrote to my friend, Karl, dated November 11, 1991.
Dear Karl, I changed jobs this summer. The one I have now is
more sedentary, with less involvement with social agencies. And no
dealings with the police! I must say, though, that, Mobile Crisis was
exciting. I think of you often. Tom.
A Brief Background of Sunset Terrace
And Lutheran Center
The official name of my new agency-where I am at the time of this writing-is
Lutheran Medical Center, Sunset Terrace Family Health Center. Sunset Terrace is
one of four major "sites" of Lutheran Medical Center. The other sites, all in
Brooklyn, are Sunset Park Family Health Center, Family Physician Health Center,
and Park Slope Family Health Center. Organizationally, the Family Health Center
Network is a private, nonprofit community-based organization that receives city,
state and federal funding.
The goal of Lutheran Medical Center, with its large multicultural population,
is stated boldly on the opening page of its brochure: Our goal is to provide
community residents with comprehensive primary health care and education
services which are culturally acceptable, accessible and of the highest quality." To
help meet the needs of the multicultural population, the Center employs bilingual
staff who speak Chinese and Spanish, in addition to English. They are readily
available at all locations.
Sunset Terrace Family health Center may be succinctly described as providing
both comprehensive mental health and alcoholism services. More specifically,
Sunset Terrace features a mental health program, community support services, a
24-hour psychiatric hotline, HIV counseling/testing, prenatal care, WIC (the
supplemental food program for women, infants and children), alcohol counseling,
alcoholism detox (24-hour hotline), screening and admission for alcoholism, and
substance abuse services.
The Multicultural Patient Population
Most of the patients who come to Sunset Terrace are Hispanic-mainly from
Puerto Rico, followed by the Dominican Republic, Ecuador, Peru, Columbia, and
Chile-as well as Arabic, Chinese, and Italian. The types of patient situations I
confront at Sunset tend to be different from those I encountered with the GMHP,
MCU, and other places I worked in my checkered past
For example, I recently treated a Palestinian woman from Jerusalem who was
brought in by her senior high school son. He complained that she was having
difficulty sleeping and also sometimes exhibited bizarre behavior, such as banging
her head on the wall at home. After I stabilized her with medication, she began to
talk about her concern for her son, an only offspring, whom she thought would
leave her after high school. I also learned that she had no financial or other familial
support. She wanted to return to her homeland, and incessantly pleaded with her
son to take her back.
My treatment approach for her included the Day Program and individual
therapy sessions. Also, she was encouraged to attend English classes in her
neighborhood. Soon, she began meeting with other Arab women. The son came
with her to the Center from time to time. After a while, she wanted to show us
how proud she was of her progress, and so she gradually began to converse with
us in better English and learned to write in English as well. Most recently, she
passed the U. S. citizenship examination given in English. Her son, who is
employed, continued to stay with her after graduating from high school and
obtaining an Associate Degree in Business.
This Palestinian patient, despite abandonment by her husband and family in
Jerusalem, found strength to mend her illness, substituting loneliness by
acceptance of her situation and recreating an alternative way of life. Jerusalem now
is far away, she is no longer desperate to go back there, and she has stopped
pleading with her son to return her to her former homeland.
Another example of the kinds of patients I see and the types of problems they
have involved an Italian woman from Naples, who was 30 years old when I first
saw her. She showed up in our clinic with marked agitation, carrying a baby in one
arm, and clutching the hand of her other son, aged three. Distraught, confused, and
speaking with a heavy Italian accent, she did not seem aware of what she wanted.
Nor did we. Gradually, however, she explained that she was worried about being
able to pay the rent and receiving further financial assistance. Her husband had left
her. Her current turbulent liaison with her common-law husband resulted in her
being stabbed in the abdomen, necessitating major surgery. She was fearful of both
men's mafia connections, and ambivalent about going back to Italy to her parents.
With intensive case management and medication, she gradually settled down,
accepted her divorce and the more recent estrangement from her common-law
husband. "When I am better and my boys are a little older," she said one day with
some conviction, "I will visit to Napoli." I wondered why she said "will visit" and
not "go back."
Brittle though the outward appearance of both the Palestinian and the
Neapolitan women may have been, I clearly could discern, after a short while,
their innate strength and rationale, almost as if they had risen above virtue, out of
the maze that trapped them in life's complex circumstances.
In another instance, with another patient, I was surprisingly amused one day
when a Hispanic woman corrected me because I assumed she was from Puerto
Rico. Actually, she was from Ecuador. From working with the diverse Hispanic
patient population at Sunset Terrace, I have come to appreciate the strong sense
of national pride that members of each group feel. They want to be distinct, to be
identified with their own kind, to be perceived as different from others who also
may speak Spanish.
I am glad I have been made aware of the national pride of each Hispanic group
I serve. That is one of the rich rewards I have received since joining the staff of
Sunset Terrace. Another reward has been serving as a consulting psychiatrist to
the HIV clinic-another facet of my psychiatric career-and having the
opportunity to help people cope with the anxiety, depression, and panic
unleashed by the possibility of contracting AIDS or, worse, of actually having the
deadly disease.
So although my current work setting is "sedentary"-even "normal"-
compared to riding around in the MCU, seeing patients in households and nursing
homes with the Geriatric Mental Health Program, and conducting mental health
research in Sarawak, my rich experience treating patients from diverse cultures
and subgroups continues. And so does my sense of fulfillment from knowing that
I am helping people continue to live, sometimes productive and relatively happy
lives, even though they initially came to see me in distress.
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