A Healthy Dose of Civility

Lewis Martin King is a clinical psychologist and “human development and behavior specialist” by trade, but his engaging personality and wit recall the bedside manner of an old-fashioned country doctor. A professor of human behavior and psychiatry at UCLA who served as dean of the Drew/UCLA medical school from 1987 to 1995, King was born on the Caribbean island of Trinidad during the colonial era of the 1940s and obtained his PhD in psychology at UCLA in 1972. The Place of Family, the substance-abuse treatment program he founded at King/Drew Medical Center in 1973, is the oldest program of its kind in South Los Angeles.

A passionate advocate of primary care as the cornerstone of community medicine, King also created the Frantz Fanon center for mental health research at King/Drew, and he’s established programs in the U.S. and abroad in AIDS prevention and education for foster care children. As a founding member and resident scholar of the Tom and Ethel Bradley Foundation, which brokers projects for other philanthropic agents in community-need areas, he has spent the last three years developing the foundation’s operating philosophy, a concept he calls “intentional civility.” The group’s altruistic, service-based approach has been used in projects including an annual youth think tank at USC, an anti-violence strategic initiative with the Compton City Council, a pilot program with the United Teachers Los Angeles, and a parenting program for poor and single mothers in San Bernardino funded by First 5 and Southern California Edison. We discussed ethical values, Hurricane Katrina and King/Drew’s troubled history in a recent conversation.

The Bradley foundation newsletter is titled “Civility.” Why this issue?

We see intentional civility as a “mind map” of standards we should embrace to maintain our divinity as human beings. It is not sustained at the level of schools. People we celebrate as special, like a Martin Luther King, a Mother Teresa, a Rosa Parks, we see those qualities at times of disaster like the Katrina incident, where people decided to contribute. We must be intentional and deliberate in espousing it. We can’t accidentally do it.

You just mentioned Katrina, but that was in some instances a demoralizing spectacle in terms of leadership crisis and breakdown of community.

We saw this in how governments operated. We saw it at the level of how selected members of the community operated in terms of crisis. And we are going to see it continue with this allocation of $60 billion-plus [in Katrina relief]. We are going to see incivility reign supreme. We have an individualistic, self-centered, narcissistic philosophy for living. Everything is “we,” “my own” and “mine,” as opposed to community. It is through purpose, through service that you define self. A purpose of service is at the core of civility.

How do you reconcile your orientation as a clinician with an ethical or spiritual approach to mental health?

We should distinguish mental health as a public issue involving stress in our lives, and mental health as a biological issue. About 90% of all mental health problems are informed by the first: stresses in the environment, producing violence, depression, bipolar disorders, character disorders, a range of problems. Then we have those that are biomedical, the history of the family having schizophrenia or manic-depressive disorder, and so forth. If you can reduce stress through civil discourse, you can then reduce the mental health [problems]. If you take family medicine clinics in the United States, close to 70% of the clients coming in have clinical depression because some of them live alone, they have no resources, they have no social support, they have no community. Take the issue of alcoholism. Why are they taking substances and drinking alcohol? Again you have another mental health picture that is not addressed by the physicians.

Why not?

Because there is no community. Everybody is doing individual private practice. Nobody is looking at what informs the problem in the first place. They are not addressing: Is there a theater in the community? Is there a safe school system? Is there a playground? Is there a place where people can assemble for town hall meetings? If you think about it, our institutions in the community that serve the role of problem-solving, beginning with the family, beginning with the little club meeting, have almost disappeared. All we are left with is the church. It does a good job, but it cannot do all the job.

Speaking of disappearing institutions, it has been a decade since you were dean at Drew/UCLA medical school. If the facility were your patient today, what would you prescribe?

If you understand the history of the medical center, the way it was structured was going to produce a problem. The original intention was community medicine at a primary-care level. But they decided to attach to it a postgraduate medical school through UCLA. You have lost your autonomy, so you have lost control of the essence. That’s the first big error.

The second one: You open an undergraduate medical school, and it has to be, one more time, affiliated with UCLA. Meaning that you cannot begin to prepare a culture of students committed to the very reason for the place, which is primary care. Because they are under the umbrella of a teaching hospital that is an excellent hospital, but is not committed to primary care. It’s committed to just medicine in general.

A community primary-care institution would need care professionals who may not be medical doctors.

There is an attempt to do that now at Drew. They need healthcare [for] AIDS, the chronic diseases, hypertension, cardiovascular diseases, diabetes, nutrition, exercise, obesity. Yet it’s [still] a tertiary care hospital. You come there when you are really sick. People drive in to die there. Primary care is almost treated as a second-class citizen. I created the first major alcohol treatment center in that community, The Place of Family, to address alcoholism and substance abuse in the South Los Angeles community. It sees close to 300 patients a week, all by para-professionals. In the history of that place, not a single [medical] resident has rotated through for training in alcoholism treatment. It is not seen as real medicine in our community, even though alcoholism and substance abuse cause 50% of our secondary problems [such as violence].

Is there any hope of a real community medical center at King/Drew?

The people who understand the history of that community ought to be reassembled and the issues revisited. A large percentage of them still exist and have a historical memory of the original intent. The community itself was the leading force for creating the hospital, not the physicians. Those people should be brought back to the table. And the final issue there is the lack of civility among the staff members. That has to be addressed.

But these are educated professionals. Doesn’t civility come with the package?

No, it doesn’t come with the package. That’s the problem. If you go into a high school today, there is no course in civility. When you go into the medical schools, there is no course in ethics until some breakdown takes place. They are discussing it around death and dying. But they are not discussing it around patient care and how you work as a team. It’s not that hospital alone; it’s across the country.

So we’re back to civility.

This is my life. All my life I have participated in one fundamental issue: How do we get those who have been marginalized participating fully in community?