Warm, genuine, a delightful lady, dedicated to excellence these are all adjectives that describe child psychiatrist and author Grace Ketterman, M.D. The daughter of pioneering parents, she grew up on the plains of Kansas, distinguished herself as a physician in a field dominated by men, established a unique psychiatric treatment center for adolescent girls, led in the development of a statewide support system for the families of prison inmates, and rose above the pain of personal and family tragedy. In all of this, Dr. Ketterman has never deviated from allowing her commitment to Christ to penetrate every aspect of her life, practice, and writing. Still practicing psychiatry at age 72, Grace Ketterman is a quiet, humble, inspiring pioneer in Christian counseling whose life and dedication can be a model to us all.
Tell us about your background, home life, and how you got into the field of psychiatry.
GK: I was the sixth of seven children born to a farm family who had migrated to Kansas from Pennsylvania; they were Mennonite people, very staunch, hard working, good values kind of family. My grandmother, however, had been converted to the Wesleyan Methodist faith by her husband my grandfather, whom I never knew. He was a circuit rider on the Kansas plains. So I have a very fascinating family background. We lived on a farm out-side a small town of Newton, Kansas, and went to a one room country school, where there were 20-25 students with one teacher. All eight grades were represented and I was the only one in my grade for eight years. Then I went to a high school where I was one of 200 in my class one of the major transitions of my life. The value of work was high on my list from early in my life. During the distresses of the Great Depression, every family member was needed to help make a living, We were truly a team. When I was only 12, I worked for a neighbor. We worked hard at cooking for their farm hands, gardening, cleaning, and a list of chores. For some eight hours, I received the magnificent sum of $1.00 total. But I felt rich!
During high school, I worked in a laundry, served as a cashier at a restaurant, and kept my grades high. I remained active in my church as well under the ministry of the best pastor I have ever known. I did well in school, went to a church college for two years, then transferred to Kansas University just as World War II veterans were all coming back again, a transition from a very small school to a very huge number of people. In college, I served as housemaid, worked in a ladies clothing store, graded papers for a professor, worked in the bacteriology department and the school cafeteria. I was ready to apply for med school in my senior year, but I thought I might not be accepted because so many veterans were applying, and they deserved preferential acceptance. Women were not popular as doctors in those days. The Dean of our medical school interviewed me to determine whether I was a fit candidate. He was an austere man, and I was scared to death of him. He asked me about my work history, and I reviewed the jobs I have just listed. To my surprise, he smiled warmly and said, I see you are not afraid of hard work. And I suspect you have become acquainted with a wide range of people.
That will help you to be a good doctor! Gratefully I was one of five women accepted to med school at KU where I spent four years in rigorous training. After medical school, I did an internship in a Jewish hospital, Menorah Medical Center in Kansas City. My husband and I were married in my junior year in med school. During my internship, our first child was born, a tiny daughter who has grown up to become a wonderful psychologist. After my internship, I worked for two years in public health. There I gained my liberal education! I examined indigents, people in jail, and the prostitutes who were brought in. We had a huge VD clinic. After my husband finished school and was able to earn a living, I went back into a pediatrics residency at General Hospital in Kansas City, practiced pediatrics for six long, busy, wonderful years. I soon realized why I was always tired when I counted how many hours a week I was spending at work one week it was 100 hours. So I knew I had to make some changes. I was offered a fellowship in child psychiatry, and that enabled me to limit my practice. I have been in psychiatry ever since.
In those days when you were beginning your practice, was child psychiatry primarily a male profession?
GK: Medicine was very much dominated by men there were five women in my medical school class of about 75. In my residency, I was the only female in all fields of medicine in our hospital, and for many, many years, women were very much in the minority. That began to change probably in the late 70s, and now there is an equal number of women maybe more. So it has changed a lot.
What was it like being a Christian in this kind of secular environment a Christian, child psychiatrist, female? This sounds like an unusual combination.
GK: When I started to think about going into psychiatry, my younger sister, who is a registered nurse, warned me that psychiatry was pretty secular and in fact, she believed, atheistic. She was really concerned lest I be dissuaded from my faith. So I was very cautious and spent a great deal of time in prayer, in communication with the Lord, and in spiritual fellowship in my church and Christian groups throughout my training. God really helped me avoid those pitfalls of doubts and has helped me to coordinate Christian principles and biblical truth with my psychiatric training. Its been a wonderful walk.
Describe some of your early years at the Florence Crittenton Home for unwed mothers.
GK: After my two-year fellowship in child psychiatry, I stayed on staff at the hospital and, again with guidance and help, did the lion's share of the work in developing the first inpatient program for adolescents at Western Missouri Mental Health Centera wonderfully growing, learning experience for me. Then the state mental health system became unbearable to work with and most of us in the Child Psychiatry Department who had grown together over those four years left. I needed more time with my family by then three children. I took a position with a maternity home, the Florence Crittenton Home, and worked with unmarried mothers, most of them teenagers. It was perfect for me. I had pediatrics experience so I could take care of babies. I had my training in psychiatry so I could help with the mother's problems. I had some experience by then with families, so it was a great job time limited, crisis oriented, lots of time for my family it was a good era of time.
After about three years of that, I encountered an incredibly rapid change in the unwed mother scene. Teenage moms either got abortions or they kept their babies, and the need for the shelter of a maternity home became negligible. In three months, we went from thinking of adding on to our building because there were so many unwed mothers applying for shelter to so few applicants that we could not pay our bills. We researched what the needs of our community were and found there was no treatment center for emotionally troubled adolescent girls. There were treatment centers for boys and younger kids, but not girls. In my ignorance, I decided to move toward developing a residential care center for adolescent girls. God helped us get that program going, and as I realized how massive the need was, I helped raise about six million dollars over a couple of years to build a wonderful, 100-bed children psychiatric hospital on 150 acres of land. With our administrator, we developed a very unique, successful program, very scripturally oriented, very definitely faith oriented. After about 15 years of very good success with this program, the health insurance business took a turn for the worse, and the ability to keep kids long enough to do the kind of definitive work they needed just dissipated our efforts. We went from about three month's average stay in the residential program to about three weeks maximum. That's now diminished to about five days. So the entire program that we had built had to be changed and unfortunately has never been restored to the good quality of its earlier years.
How have you managed to integrate your faith and practice?
GK: I think the main thing is the absolute certainty I have that Gods truth is The Truth. Whatever seems to conflict with his truth has got to be understood and explained. Sometimes its a matter of understanding and explaining; sometimes it's a matter of saying Hey, I just have to disagree with that I can understand that theory or technique, but I do not really agree with it. God has honored my commitment, and I think the Holy Spirit really is the bearer of truth. He is the spirit of truth, he really guides us, and knowing that certainly helped me stay truthfully committed to my faith in practice.
Give us an example of when your Christian faith has had a significant role in your work in child psychiatry.
GK: In my training days, I remember working under supervision with a Christian family. I was taught very emphatically not to talk about religion, but I dared to differ with that, and when I felt really guided, prompted by the Lord to talk about faith, I did. This particular family had a good church background but they'd walked away from it and were not very involved in any church. Through the problem they had with their son, the pare nots realized they needed help, and they were very willing to talk about their faith, where they'd lost it, and how they wanted to get it back. My mentor at that time was kind of an out-of-touch Christian, who since has come back to a marvelous walk with God. He has told me that he thinks a lot of depression really is due to the fact that people, like this family, have lost touch with their faith. They go through a grieving experience grief and depression can be so similar and I have thought about that a lot as I have worked with people.
How have you seen the field of child psychiatry change over the years?
GK: Well, its moved from more of a Freudian, developmental kind of specialty to a very permissive specialty. A lot of respect is shown to children, and I believe in showing respect. But showing respect has taken precedence over teaching the children respect. So much respect is given to them, but they are not taught to give that back. Grace (1st row) in a field dominated by men! In the psychiatric field, we have gone from counseling and family guidance, family therapy, and pare not guidance to a lot of medication. I fought that as long as I could, but as more discoveries came along showing how much physiological change there really is, I have had to say that medication is a gift from God, just as penicillin is for strep throat. So I use psychiatric medications, but that's kind of an adjunct to the insight, supportive, guiding kind of work that I do.
What other kinds of changes have you seen over the years in terms of treatment, especially of children with psychiatric problems?
GK: With the changes in managed care, our goals shifted from finding reasonably complete healing of the child and family that enable a child to go back home and live successfully with his or her family. At one point, for five to seven years, we had 75% to 80% success with our kids, in terms of not having recurrent hospitalizations, not having legal problems, and their being able to adjust in their homes and communities. We went from that success rate to being unable to measure change. And from doing good counseling, we went to being able only to offer kind of a cooling-off period for families in crisis, a chance to medicate the patient, and hopefully line the child up with an outpatient aftercare program.
How is Crittenton treating most children today?
GK: They are getting very brief inpatient care, and then they still have what we developed as a day program a very special, wonderful school where kids have academic success, some ongoing counseling, and some recreation therapy. They have continued to focus on very intense family therapy, which is key in making any progress at all.
Would you say then that the insurance industry and managed care are setting the direction for Christian counseling?
GK: To some degree, and in a horrifying way, yes they are. When I reached the age of 65, I realized that I needed to retire from the heavy load that Id carried. So a new medical director was hired, and I tried to stay on as an adjunct and a mentor. Unfortunately, the new director was not interested in my mentoring or any Christian approach. I no longer had an influence in hiring staff, so as I saw things deteriorate, I offered everything I could to salvage the spiritual values, and finally I knew I could not handle the grief over the awful loss of so many good things, so I retired about five years ago.
What have you been doing since your retirement?
GK: I do half-time private practice, which is very different, very rewarding. I love my private patients, and I have continued to do a little writing. I have some time for my grandchildren, and I really have a great life.
How did you get started in your writing career?
GK: You know, that was a really fun story. I began telling patients who had unique experiences that I wished they would write about them, because those experiences are similar to others and they could be very helpful. A patient finally said to me, You're always telling me to Write why do not you write? So I said, Well, I do not have time. Someday, if I break a leg, I will write. A couple of years later, guess what? I broke my right ankle, and while I was laid up in bed, I had two invitations to write. One was from a little Christian Sunday school periodical, and it was agony to write only 200 words! But a friend then decided to write a book on teenaged rebellion and thought that I could help with that, so I wrote Teenage Rebellion with him. The publisher must have liked my style or what I had to say, so I had more and more invitations to write. I have never had to go through the horror of having a manuscript rejected, because I have written at the request of publishers.
Are there any of your books that you have felt especially good about?
GK: A little book called Understanding Your Child's Problems is my favorite. I had a spiritual growth spurt during the writing of it, and I did a lot of Scripture research. It may still be in print. That's probably my favorite but not the best seller. The most successful book has been a little paperback called When You Feel Like Screaming that I wrote in conjunction with Pat Holt, a teacher from California. That book has had a long and vigorous career. Only recently, it has been translated into Spanish.
What are you working on now?
GK: I have just sent in a second revision of a manuscript on a book on forgiveness, relating some of the real tragedies of my life and how I learned so much about forgiving through those experiences. Its with the editor now, and I assume it will go to print soon.
Tell us a little bit about how tragedy has influenced your life and your work.
GK: Well, I have been through some difficult times as you can imagine. In pediatrics, I have lost patients. In personal relationships, I have had betrayals and a lot of sad times. A horrible tragedy hit my family in 1984 when I found that my husband was in jail. We had had some difficulties, and I just could not reach him anymore. There were a lot of difficult financial stresses and debts, as well as a number of losses and grief. I tried to comfort and help but could not. I suspected he was having an affair, so finally I filed for a separation and eventually for divorce.
About three months later, we went out to dinner one Sunday evening and he was berating me for this divorce, because he really wanted to make our marriage work. I said I'd like nothing better, and if he could change, I was certainly willing to change. Still he berated me, and I could see that he was not really making the spiritual and relational changes that he needed to make. Less than 48 hours later, he called me from jail. He had only a minute to talk, just enough to give me a piece or two of information that I had no knowledge of. He had become involved with a woman patient, who had used her teen aged daughter as kind of a seduction-bait. I do not know what else to call it. Now he was accused of child sexual molestation. After almost a year of devastation, he was sent to prison, but on that first phone call, I received incredible insight. The information he gave enabled me to understand what had been going on and how devastating it was. Yet somehow I was able to say, I see, I understand, I can forgive you, and the kids and I will stand by you and help you through this. I still had no idea of ever getting back together with him, but at least I wanted to support him through this. It was a nightmare a terrible time for him, for all of us, but somehow I was able to keep going. At one point, I began to see it was Gods tough love that was teaching my husband how to come back to fellowship with him.
I went to visit him almost every week with a friend whose husband was also in prison. My friend and I developed a prison support group for families and inmates that is very active throughout the state of Kansas (in every prison we have an outreach to families). After four years and a few months in prison, Herb was released. Two years after Herb was discharged from prison, we felt that we knew each other again well enough that we could remarry. We have had a wonderful marriage, but it certainly took a lot of grace, a lot of understanding, and a lot of forgiving to provide healing and the healing is a complete process at this point. Because of the publicity, people have known about this situation in my life. Wherever I go to speak pastors groups, counseling groups, teachers have found audience members who approach me with, If you could do this, then I can do it. So I think God has, in fact, used the tragedy in my life in a very wonderful way.
In what ways have you thought of yourself as a pioneer?
GK: I see myself as the daughter and granddaughter of pioneers. My grandfather was the first family member to come to Kansas from Pennsylvania leaving behind his whole community of people. In my grandmothers day, to have left Pennsylvania and come to Kansas on a train alone to marry someone she knew for only two weeks was certainly pioneering. I have great respect and admiration for my grandparents and their kind pioneer spirit is in my blood. For a farmer, my father's beliefs were rare in valuing education. He wanted to be a physician but had no opportunity. So he urged all of his seven children to go into medicine. I was the first one with whom he was successful. I think my applying for medical school, even aspiring to such a career, was quite pioneering in its end. Women in medicine were thought of as pioneers in that day. To continue working even after I had children which perhaps I would not have done, had I had hind sight was also pioneering.
What observations do you have for people who may be considering working with children?
GK: Working with children is hard work, not very good in its pay. When you see people for an hour, you cannot charge the large fees that even family doctors charge for a quick emergency a few stitches and a big fee. If you are altruistic enough to give up caring so much about money and more about preventive work, you will be able to work with children. As a twig is bent, so grows the tree. If we can help parents with a troubled child, we help the entire family. And if we can help that child before he or she is I immersed in difficulties that will result in crimes and Imprisonment, what a huge economic advantage it offers our culture, and what a wonderful personal joy it is to see that kind of work!
What observations do you have on the state of Christian counseling?
GK: I think Christian counseling sometimes gets a little superficial. In our community, there isn't enough of the family approach, not enough group therapy. I was trained thoroughly in group therapy back in the 70s, but even I do not use it now because its difficult, very hard work. Find a counselor for suggestions.
So, how do we keep Christian counseling from becoming superficial?
GK: I think by the kinds of thing that AACC does: by conferences, by emphasizing academic responsibility, by insisting on good training, by being well read and up-to-date with current knowledge and research.
Perhaps we all should do more research and more sharing of research. I think this is where Christian counseling has an edge. The best thing I offer my patients is a caring heart. When they know that they are important enough that I can shed tears sometimes with them, I can laugh with them, be angry with them it does something that I think no techniques in the world can do. That's what God wants to do through his followers in counseling!