Contemplation

On Thursday night, I bought a book-- an actual 8" x 5 1/4" paperback book at Borders. That's right. Pin a medal on my shirtfront at a ceremony featuring a marching band and ditheringly platitudinous speeches made by gray-sideburned men in frockcoats and tophats. I am doing my part to keep a sinking vessel afloat. I am the savior of the ship.

$14.99, plus $.90 to account for Pennsylvania's 6% sales tax, doesn't get you much at Borders these days. Yes, it will get you a fru-fru drink from the café and a rather untowardly-sized chunk of coffee cake, and it'll also get you some horseshit stationery pack-- not that anybody actually writes letters or cards anymore. It'll get you probably a small amount of actual books-- "The Abridged History of the American Firearm" from the discount section, or perhaps a paperback school edition of "Hard Times."

It got me "The Center Cannot Hold," by Elyn R. Saks. I'm 280 pages out of 336 in, and I'm frankly surprised that I've been able to take a break long enough to write a blog post. But, hey-- it's Sunday night and I've got work due on Monday morning, at 7:18am. Great expectations.

It's a remarkable book by a remarkable lady. A graduate of a Masters program at Oxford University and Yale Law School, Elyn Saks also suffered from grave mental illness, causing her to experience hallucinations and delusions, resulting in her being hospitalized both in England and America. She had countless encounters with full leather restraints, as well as countless encounters with psychiatrists, analysts, therapists and doctors who did what they thought was best to help her. Some were on the right track, some not so much so. Her book is heartbreaking, inspiring, frightening, unsettling and glorious, for she is able to elucidate and describe what a psychotic break looks like, feels like, sounds like, smells like, and talks like.

"Head explosions and people trying to kill. Is it OK if I totally trash your office?" Saks queried one of the physicians she'd been working with during a particularly bad break. Eating, bathing-- what was that? There were anonymous people trying to kill her everywhere she looked and her own "head explosions" to deal with every second of the day.

As a person who works with people who suffer from mental illness, who has had very little educational or clinical experience prior to this job, it is absolutely essential (for my well-being and for the patients) that I soak up whatever knowledge and experiences I can. Christ knows I am not going back to school for psychology at age 30, and I've already been to numerous trainings on trauma and Stage of Change theory and roundtable discussions with psychologists and psychiatrists, but I have learned more plowing through 2/3rds of Elyn R. Saks book than I have from all of those trainings and packets and handouts and motherfucking PowerPoint presentations.

Of course, I learn from my patients, too. I learn from what they tell me, and what they don't tell me, what they hear and what they think they're hearing. In the psychoeducational groups that I run, I learn as much as I teach-- maybe more. I learn from the interactions I witness between staff and patients-- the good interactions and the poor interactions, and I'm getting so I can differentiate between the two.

Really, it's not too hard.

I do a lot at work. I teach the groups. I interview patients. I counsel, I talk-- but the most important thing I do is listen. The opportunities patients get to talk-- to really talk-- to staff are few and far between, and some days they give me twenty patients to see, so the temptation is to wham-bam, thank you, ma'am. But I can't do that. I'm not that downtrodden yet. So I make more time. I come into work half-an-hour early, even though I do not get paid for it. I have an hour lunch, but, most days, I wolf down my food in fifteen minutes and head back into the building. I'm no martyr and I'm no saint, but what's the point in my being there if I'm not giving all I can?

While I do a lot at work, the one thing I really don't witness or participate in are the therapy sessions-- because they're between the patient and the psychologist, of course. I would love, though, to be a fly on the wall during some of those sessions-- to see how the psychologists handle some of the most challenging patients in the state, to see how the patients react-- to maybe gain something vicariously for myself-- some little snippet of wisdom or a seed to plant in my own little garden.

My garden.

I feel like I've neglected it a little bit. The last time I sat across from a therapist was ten years ago-- in college. It made sense for me to go to therapy as an undergraduate, after all, college is the most selfish time in a person's life: it almost seemed a sin to go through college not spending at least fifty minutes a week talking about yourself. I went for just over two years-- spending a year-and-a-half with the same therapist, whom I adored. The sentiments were reciprocated, and it was good. Of course, at the same time, it wasn't good.

"I was seducing him," I told my wife at the kitchen table yesterday morning. She raised an eyebrow. "You know what I mean-- not like that. Like, getting him to believe I'm special, like I was entertaining and good and funny and nice." And he bought it. "I've got to tell you," he said to me one time, "I almost feel guilty about how much I enjoy the time you and I share together each week."

What a thing for a patient to hear. I ate it up like Borders Café coffee cake. The fact that I remember that and not much of the actual counseling shows you how much his sentiments meant to me.

I've been thinking lately, perhaps spurred by Elyn Saks' innumerable therapeutic contacts, perhaps by the recent turmoil and depression that has hovered like a raincloud over my family, about a return to the couch. Or the chair, depending on the modality of choice, and I don't know how I feel about it. I now have insurance that covers in-network mental health services-- up to a point, of course. I'm not rehearsing for a show, so I'm kind of out of "time excuses." But I don't want to spend time and money... performing for someone, trying to reel them in and seduce them, and I don't know if I'm powerful enough to make myself not do that.

And I don't know if it matters, if I'm also getting the help I want or may need.

I guess you could say I'm in Contemplation, to use the language of my current trade. And I've gone in and out of that stage every so often during the last decade. I don't know what I'll end up deciding on, or if I'll move out of that stage into something new. For now, because I have reality-based thought processes, a supportive, loving wife, a relatively non-clinical family, and you, my center is holding fast. And, one way or another, I am determined to be the savior of my own ship.

Sometimes, It All Just Goes to Shit

I didn't get much sleep the night before I was scheduled to teach drama therapy in my quaint litlte psych hospital. To the best of my knowledge, it had never been tried before. And I had absolutely no empirical or therapeutic basis for what I was preparing to do-- which, frankly, wasn't much.

I stared up at the faint, dark outline of the ceiling fan as the rhythmic thrum of the air purifier mixed with my cataclysmic thoughts of how drama therapy was going to go down as the single worst idea in the history of the therapeutic milieu.

I was very worried it would end up looking something like this:

I'd, of course, be one of the fuckers getting his face stepped on.

My supervisor, who has a rather inflated opinion of my capabilities, decided to schedule me to do two rounds of drama therapy, once on the general unit, and once on the lock-down, acute unit. Drama therapy in the land of the bolt-down tables? Was this practical, or was it even possible?

Before I go any further and make it sound like my supervisor is entirely to blame for me trying out something like this in a mental hospital, I should point out that I, um, signed myself up for it. Three weeks ago, I put down on the calendar that I would like to try out drama therapy on the 17th. I do this kind of thing to myself a lot. I'll sign myself up for something, as long as it's at least two weeks away. If it's happening tomorrow, even if it's as innocuous as a television show I've just found out about, or dinner with a friend, I'll turn it down. It's just too soon. I don't roll like that. But, I'll book myself for pretty much anything if I can perceive that it's far enough into the future that I don't have to worry about it, yet. Public execution? Sure, I'll take pictures-- it's in a month, right? Pubectomy in six weeks? No problem-- I'm there.

In a way, I felt obligated to sign myself up to teach drama therapy. When you come into a job for which you're completely unqualified, and they find out that you're a theatre major-- your sorry, skinny ass is pretty much going to teach drama therapy, like it or lump it.

So I did my half-assed, haphazard preparations the day before. Because that's what I do. I was practically trembling as I walked into work on Friday. I looked at one of my coworkers.

"This is going to blow up in my face like a cake that says, 'Happy Birthday, Hindenburg' on it, isn't it?" He smiled wanly.

"Well, it may, but, remember," said my typically sardonic cohort, in a rare, sincere moment, "you may have the best idea in the world for a group therapy session-- and that doesn't mean it's going to work, and that's not always your fault. Sometimes, it all just goes to shit."

Oddly enough, I took comfort in that sentiment as I tucked my bulging clipboard underneath my right arm with what was becoming a familiar gesture.

"Oh. The humanity," I said flatly. I sighed briskly. "Okey-dokey: here we go."

A patient encountered me in the hallway on my way to the activities room.

"What the hell is drama therapy, guy?"

"Well, you're just going to have to come on down and see what's behind Door Number One in order to find out, aren't you?" I said with game-show enthusiasm. The more truthful answer would, of course, have been, "I have no. Fucking. Idea." But I couldn't say that. In the land of steel doors and cinder block walls, the man with the clipboard and the keys had better have a fucking idea, or be very good at faking it.

Halfway through the actors' warm-up exercises, Theresa (name changed) was smiling. I hadn't seen her smile in three months. Her psychiatrist was peeking through the window in the closed door, and her eyes were popped wide. Other faces, those of coworkers, crowded around the small window, peering excitedly at the strange spectacle of teacher and patients, leaping about the room enthusiastically, doing vocal warm-ups, doing scenes, working together, stretching, being silly. It didn't go pitch-perfect of course.

"Okay, Olga," I whispered to a patient with whom I was doing an improv scene, out of earshot of the rest of the patients, "in this scene, I'll be your son, and you're my mom, and I've just broken your favorite lamp. And we'll improvise a scene and the other patients will have to try to figure out what we're doing."

We walked back into the room where all the patients were waiting, and the first thing Olga says to me is,

"Why'd you break Mommy's favorite lamp, sweetie?"

After the group ended, after any group ends, I had difficulty taking stock of the situation. When you're in it, you lose yourself, and time, and your brain is working feverishly to make sure patients are engaged, not ripping each others' faces off, or licking the armchairs. It was 12:00pm before I knew it, and people filed out of the room. They were smiling, giggling, chatting with each other about what they had just done. A male patient, who did not participate at all, but sat and watched the whole time ("What is drama therapy," I asked him, "without an audience?") looked up at me and said,

"You know what I liked the most about that group?"

"No," I said, "what?"

"That Theresa smiled. You did good."

No, I thought-- they did good. They could have blown me off. Could have said, "Fuck this-- this is gay. You don't know what you're doing." But they took a chance, they went with it, and it went really well. And I guess I'm proud of myself, not because the group went well, because I could do the exact same thing next week with a new set of patients and it could absolutely tank, but I'm proud of myself for volunteering myself for something scary. For not pussying out. For taking a chance. For embracing being green at something, and not hiding behind the safety net of the same old thing.

Besides-- I had fun, too.

Imagine

When I walked into work yesterday, I slid my identification card into the electronic time clock, signed myself up for my assignments for the day, nursed my coffee and nonchalantly eavesdropped on some of the pre-workday conversational chatter I'm not yet confident enough to join in on. See, when you arrive for work for a 7am shift at 6:40, you sign up for assignments inside the nurses' station and you are actually not permitted to enter the unit until 7:00am on the dot. So, you sit or stand and you chat or you listen.

Yesterday, I listened. And I heard that a patient, a 23-year-old young man who was discharged just a few days ago was dead.

"He just walked out into the middle of the street, right in front of a car."

They don't know for certain if it was a suicide, but, when you have an incident like this, befalling a recently-released former patient of a mental institution who had been expressing suicidal ideations and bizarre behavior, well, even I can put two and two together and get pretty close to four.

For the purposes of this blog, we'll call the recently departed "Ellis." I first met Ellis about three weeks ago. I was sitting in the activities room on the Acute Unit, writing a report, and he was shuffling towards me. I saw him from out of the corner of my eye. When you work in a psychiatric hospital, filled with prisoners and assaultive patients and convicted murderers, mixed in with the just plain manic, bipolar and disorganized, you tend to use the corner of your eye a lot more than the eye itself. I guess that's why a peripheral vision test is part of the pre-employment physical. It's kind of a big deal.

Anyway, Ellis was shuffling over to me. He had no shoes or socks on, and he was wearing a pair of black and red checked pajama bottoms and a black t-shirt that was full of holes. He had stubble, but it was kid stubble, the kind you could shave dry if you wanted to, maybe once a week and nobody'd notice. His hair was, well, fucked up. Light socket style-- Emmett Brown kind of a thing. It looked as if a bird, or several birds, had been nesting in there for a few months. His teeth were in disarray and, as he approached me, I put down my pen and looked at him.

"Can I talk to you, please?" he said to me in a small, meek voice.

"Sure," I said, "pull up a chair."

And he did. I really don't remember what we talked about, to be honest with you. He told me that he'd been a drifter for a while, I think, and that he'd gone off his meds, and that he was looking forward to "getting everything straightened out." I asked him the standard question we ask everyone, "Do you have any thoughts of harming yourself or anybody else?" He said "No." He appeared able to carry on a legitimate conversation. Five minutes after he walked away from me, he was taking off his clothes in the middle of the hallway. Maybe half-an-hour later, he had to be redirected for wandering in and out of other patients' rooms, ignoring directions, and for trying to escape onto the general ward through a secure door.

He shuffled down the hallway as if he were impervious to his surroundings, as some of our patients do, and believe themselves to be. He had to be watched closely, his behavior was unpredictable. But, after three days of good behavior, he was moved onto the general ward. There, he isolated himself, occasionally going to a group or two. Just a few days ago, I was monitoring the hall, and he shuffled towards me again.

"Can we talk?" he asked.

"Definitely, Ellis. Have a seat."

He talked, and I listened. Again, nothing remarkable. Not much I can really recall. Maybe that says more about me than it does about him. But it's kind of funny because I usually have such an uncanny ability to memorize dialogue and recall what patients say to me, but not Ellis. For some reason, his complaints or questions or statements just sort of blend into the milieu with dozens of other patients I've seen and talked to and interacted with.

But Ellis will be remembered by me as the first patient I ever heard play the piano at our hospital. One day while doing rounds, I walked towards the piano room, which is really never used for its intended purpose, and I heard a sound that made me stop for a moment. It was music. Music amidst the paranoid ramblings, the swearing on the payphone, the frustrated refusals of patients who won't take their meds because they "distort my face" or because the nurses are "poisoning the Crystal Light." There was music. I softened my step, so as not to disturb the beautiful, soft, pedaled strains of a song I recognized, but wasn't too big a fan of.

John Lennon's "Imagine."

As I walked past the piano room, pretending to be more interested in my rounds checklist, I glanced out of that trusty corner of my eye and saw Ellis, sporting his unmistakable, haphazard hairdo, seated at the piano, playing from sheet music-- I don't know where he got it. And, standing there singing, in a soft, sweet voice, was a one of my favorite patients-- "R," the religiously-preoccupied lady with a tidy sum in the bank, who won't use it until God speaks to her, and remains homeless to this day. "God," I thought as I passed the room, on my merry way, "what a pair."

And now Ellis is dead, "with God," as R would say, and I wonder if she knows that her accompanist is gone.

Dear Psych Patient...

... Hi.

I'm First Name, Last Initial. Pleased to meet you. Sort of.

I'm going to be your psych tech for the day. I am hoping for a relatively taciturn eight hours with you, and I hope that you are hoping for a somewhat tranquil eight hours with me. It would be really great if you were asleep in your room for the duration of that time period, but I acknowledge that it is not particularly theraputic for you to be sleeping between the hours of 7am & 3pm, thus missing breakfast, and lunch (and two whole smoke-breaks.... eeeep!) and so, bearing in mind that you will most likely be awake for the duration of our time together, (maybe you'll go down for a four-and-a-half-hour-power-nap-pretty-please) it would be great if you could make a concerted effort to read and attempt to adhere to the following guidelines for an all-around awesometots day.

Please, dear patient, do NOT....

urinate where other people can see you.

use the bathroom sink as a receptacle for your feces.

ask me what time it is, what my name is, if you're going home every two-and-a-half minutes.

run at full speed down the hall like you are an Acela train. That scares people.

refuse to eat lunch, throw it out and then, five minutes later, ask for another lunch.

slice your skin open. All that red stuff belongs on the inside.

soil yourself. Come on, now. You're Jesus, you're not a one-year-old child.

vomit on the receiver of the pay telephone. Other crazy motherfuckers have to use that shit.

ask me if you can try on my wedding ring. That's creepy.

nucleafart in a 20-yard radius of me. The devil isn't in your brain, he is clearly up your ass.

have sex with another patient. We are required to physically pull you off if we catch that nast.

shit in the clothes dryer. Really.

Please DO...

sing. Because that is invariably, without qualification, entertaining. Especially when it's "Head, Shoulders, Knees, & Toes," and you're a crazy homeless, 56-year-old black man with a snaggle tooth, and you're touching your feet for "Head" and your knees for "Shoulders."

socialize with the other patients in the milieu. Because then we get to write notes utilizing the word "milieu" and that makes us sound intelligent.

make every effort to keep your hands off your genitals and the gennies of others.

eat facing away from me. Watching psych patients eat is harder than watching actors eat.

play "Tic-Tac-Toe" or "War" with me while I'm on hall duty. It passes the time for both of us.

write a complaint form when a staff member is inappropriate. I can't seem to get anybody fired here, but maybe you can.

your laundry. You smell.

Oh, The Humanity

I almost threw up at my new job yesterday.

It wasn't because, as a psychiatric technician and allied therapist in a psychiatric hospital, I am exposed to pee-pee and poo-poo, and patients who enjoy creating mayhem and artwork with both. No, I don't especially mind that. It also wasn't because I am exposed to patients who like to... expose.

"lookatmytitslookatmytitslookatmytitsaforeifuckinkillyoumotherfucker"

I... didn't. And, fortunately, she didn't, either.

I almost threw up at my new job yesterday not because of the patients, but because of the staff. My coworkers. My.... peers.

I almost threw up, but I didn't-- because I couldn't even bear the thought of eating after what I saw and heard today at work. Plus the fact that my day started at 7am and my lunch break was at one. What was the point? My appetite was ruined, as was my outlook on mental health as a profession, and my faith in this facility and my zeal for this job.

Gone. Awesome.

Patients were openly ridiculed by staff, openly insulted, openly... threatened.

Staff Member: "How 'bout I come over there and cut you? I'll come over there and cut you so bad your own mother won't recognize you. I'll fuck your motherfuckin' shit up."

Staff Member: "I'm about ready to shove that walker up your ass."

Staff Member: "Hey, did you know that everybody with your last name is a fuckin' queer?"

Staff Member: "Can you say, 'I'm the turtliest turtle in the turtle pond' while wiggling your head around?"

Staff Member: "Do you even know what your name is? Do you know how to tie your shoes or are you still wearing those retard referee sneakers?"

Staff Member: "You're a homo."

These same staff members would then harshly reprimand patients who exhibited sexually inappropriate tendencies-- which isn't hypocritical at all. They fudge paperwork, they slack off on the ward, they're all related or they're all fucking each other-- or both-- and their inattentiveness and inappropriate actions and reactions led to an outburst of violence today that could have been avoided.

They're mostly tattooed college kids-- one has multiple lip-piercings and, really, I wouldn't mind the lip-piercings if they were on the lips of someone who was even mildly appropriate with the patients. They make fun of patients, imitating the noises that the most severely disturbed patients make, right in front of them. To them, in reply.

When a patient approaches a staff member, the default response is invariably,

"WHAT?!"

or "What the hell do you want?"

Or, they're just ignored. A patient can be standing three feet away from a staff member (this is the required distance we're supposed to keep from them) asking a perfectly sane question like, "Do I have courtyard privileges today?" and the patient can be ignored for any number of minutes. But it's the direct verbal abuse that made me want to vomit, and I probably would have had there been anything in my stomach.

Fortunately, there wasn't.

When I took this job, I didn't think it was going to be all peaches and plums, or even apple tart, but I didn't think I would be working with people who exhibit such routine and such open hostility and disdain for the patients supposedly under their care, I didn't think I would be working with the scum of the earth-- disenfranchised people in it for the paycheck and, apparently, the opportunity to fuck with people who have limited cognition, limited coping skills, and unlimited vulnerability.

Yes, the patients are inappropriate-- but they have that excuse of being, you know, crazy. Schizophrenics are supposed to act bonked-up, the psych techs kind of don't really have that excuse. We're not supposed to be the borderlines and the manics and the bipolar.

But, it's not just the patients who get "institutionalized." It's the staff, too.

Management likes to make a bit to-do about the fact that many people who work at this facility have been there for fifteen, eighteen, twenty, even twenty-eight years. And that sounds very nice, but when you see the burn-out, when you see the hostility, when you see brutality-- well, maybe such longevity isn't such a great thing.

It sounds stupid to say this, but I think that the openness of the obscenity-laced, threatening interactions with the patients, which the technicians then tried to manipulate to confuse the patients into forgetting what they had just said, that openness was the most horrifying thing. There are supervisors and nurses and videocameras everywhere-- and, clearly, nobody seems terribly concerned about that. And, clearly, I can't imagine anybody would be terribly concerned or surprised if I reported this to my supervisors.

Hopefully, the state will be both concerned and surprised when I find another job, posthaste, quit this one and report it to the Department of Health and Department of Public Welfare.

Sometimes I joke about being twelve-- when I call my closet's green doorknobs "Elphaba's nipples," I feel twelve. Oftentimes, when I get a new job, I feel twelve, too. I get wooed, positively swept off my feet by lofty mission statements and palaver from VPs and managers about proper protocol and professional conduct and ethical standards, and they pile horsehit lovingly onto my plate until I practically need a bib.

And then.... I actually start the job.

Proverbs 31:10 asks, "Who can find a virtuous woman? for her price is far above rubies."

I know it's a rhetorical question. I know it's just supposed to be longing and beautiful. I know it's just a job. But I also know that I cannot permit myself to be counted amongst these people, to wear their I.D. badge, to park in their lot, to swipe at their timeclock, to sign my name on their papers. And maybe that means that I think I'm rubies and they're costume jewelry.

And maybe I don't give a damn if it does.