I remember the day in my first pastorate when I received a call from a psychologist asking me how many referrals I might be able to give him. The backstory here is that he moved to our very small, rural setting to work at an alcohol-recovery treatment facility. In my opinion, there were two mistakes! That facility should never have purchased our small hospital just because the price was low, and he should not have relocated his family, either. Our small town was not as geographically ideal or populous as they had imagined. Even worse, they managed to get crossways with the community through some high-profile mistakes in dealing with people. They did not last long.
So here was his call. And it was not difficult to figure out that he was considering opening a private practice and wondering if, as a last resort, it was even a possibility. His tone of voice was almost imploring, and he offered his hopeful scenario of how many referrals there would be. "Two or three depressions a month, and then other things?" he wistfully suggested.
Well... dealing with Missouri farmers... and the small-town awareness of who goes to what office and how often (including the pastor's study)... and a healthy grapevine... leads to stigma and avoidance. By the bushel! We may HAVE
problems around here, but we don't ADMIT we have problems... and we certainly don't let anybody ELSE know we have problems! Besides, you don't need to be a CLOSE relative of somebody we know, but you DO need family connections in the area to be credible! It's an interesting mindset.
"No, I'm sorry," I said. "I don't think you will have that many clients in a year if you set up a local office. I'm not saying its right, but I am saying that's how it is."
Crestfallen, he understood. He regretted moving his family and tying his future to an unfortunate business plan. No need to do it again. But he didn't know what his future would be.
Yes. I encouraged him as best I could and the call ended. But I've never forgotten the many dynamics contained in that short telephone call.
In time, my career shifted toward the military chaplaincy where I dealt with the same types of denial, perceived invincibility, and stigma as suicide and military sexual assault exploded within the force. And recently, because of the changes in farming methods and technology, the expectations of continuing the family legacy, and the pressures of time and money... it turns out farmers have an incredibly high rate of suicide. (As an example see https://sprc.org/news/why-are-americas-farmers-killing-themselves-in-record-numbers/)
Looking back, I don't know how I could have given him better advice and encouragement in that difficult setting for psychological care. But I also wonder what the outcome might have been today if he had stayed, persevered through some lean years to establish a practice, and grown into our rural community by establishing trust and cultural competence. If so, would we have more farmers today?
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