The Fictions of Our Healing

I spent today on the partial unit because they were short-staffed due to something about a state inspection. Hopefully they only reviewed charts that I have not yet touched, because I doubt that my paperwork wherewithall is on par with state regs at this point.

And also, it's a "partial hospitalization" unit, not half a hospital wing. It can be a bit confusing when we healthcare professionals toss around the medical jargon, I know. Basically, the patients come in for a day of structure and group therapy and return home around 2:00. They need more support than just weekly outpatient therapy, but don't require the constant supervision of inpatient care. Anyways.

My brain and schedule have been so full lately that I fear I have not been on the lookout for "bloggable moments" as much as, say, mid-July, when my life was to file my nails, eat bon-bons, and pine for my husband. How things have changed! Now I get up at dawn, eat cafeteria food, and pine for my husband.

So I was thankful when, just this morning, a bloggable moment basically smacked me in the face. It's my honor to bring it to you, and hope you find some worth in its reading.

Picture a room, large enough for two long tables pushed together on one side (for lunch, therapeutic recreation, and psychoeducation group) and a circle of a dozen or so chairs on the other. A noisy air conditioner in each of two windows stands silent, abandoned in favor of audible therapy. The air hangs heavy with the remnants of this morning's muddy coffee and the closeness of fellow sojourners about to bare their souls. There is one empty chair in the circle, and a girl jokes that her hallucinations have a place to sit today. This is a place where the lines between reality and non-reality tend to shift around a bit, and are sometimes ignored altogether.

Reality. For one weathered man, reality is a foreclosure, an abusive wife, and a suicide attempt two weeks ago. For the new girl, it's somehow picking up the pieces and her baby girl and moving on from the suicide of her live-in boyfriend. The quiet lady in the corner is "down" today; yesterday she was "up" and couldn't stop fidgeting, drawing, talking, drinking coffee. The other therapist and I value reality and work so that our patients are in touch with it; our patients, on the other hand, would sooner spit on it than live it. And they tell us so.

This is a tough crowd. A cynical bunch. What does a white-bread little girl know about reality? They want to know. I'm a no-fat double latte to their whiskey on the rocks. Oh they're kind, they let me sit in their circle and ask polite questions about their troubles, offer bland suggestions about deep breathing and challenging negative thoughts.

As though I'd be coping just fine with the things they carry in those dark, tattered corners of their souls.

Enter a man with the name of an angel. He's fat, and he has a mustache and the kind of voice you'd pair with Steve Urkel if you didn't know better. He came to us for the first time yesterday from inpatient, after a brief stint in the regular hospital. Angel-guy has chronic health issues and attempted suicide by altering his meds. He's not cool by a long shot, and he hasn't been here long enough to know that the only people who talk about God are the schizophrenics with "religious preoccupations".

We had just begun morning process group, and it was one of those days when, in the words of my co-therapist, you just know you're going to haul out your crowbar and start playing dentist. Like pulling teeth, I chimed in, clarifying his allusion so that the more easily frightened in the bunch wouldn't be sent into full-blown panic attack mode. That's not a joke. You never know whose meds were adjusted by the doc yesterday.

Bless his heart, angel-guy stepped into the void of going first in group. His voice was shaky because he struggles with social anxiety (in this group, who doesn't?), but angel-guy took a deep breath and talked to us about God.

Nobody else noticed anything amiss. The other group members probably (barring auditory hallucinations) heard a guy saying, among stutters and stops, that he knows God is still there, but it's hard to feel connected with him right now because he's so depressed. My co-therapist probably heard delusions teeming with maladaptive thoughts, a sick man so intent on connecting with a mythical deity that he won't be able to discard his unhelpful beliefs and focus on his own health.

Me? I watched the paradox of reality shattering un-reality before my very eyes. In this room, where supposedly the sane lead the insane, the craziest thing of all was happening. Suddenly the fictions of our healing were fatally wounded by the Truth. We were children offering each other jellybeans for our ills while one simple, pathetic man spoke of the Bread of Life, a sovereign God who has spoken peace once and for all if we would only take and eat. He knew that reality, true reality, was somewhere just beyond his grasp, if only it would find him again.

It was a moment that loses something in the translation. But in that moment I wondered what we were doing. In that moment, my soul wept bitterly, and even now mourns, for the lost who believe they are found by cognitive therapies and relaxation techniques. Our healing is dressing mortal wounds in pretty colors if we do not offer the balm of Gilead. Our foolish reality, ignorant of the eternal God, is a tale told by an idiot, signifying nothing.

Oh, there is a place for our pretty colors and positive thoughts. I feel no less called to offer compassion and help to those who suffer in the prison of the mind. If we can liberate our patients from the chains of depression, anxiety, and psychosis, so much the better. But let us not delude ourselves into believing we have saved them from anything particularly important. Indeed, perhaps it is those with chronic and persistent mental illnesses (and other chronic health problems, certainly) who are not "cured" by our treatments and believe themselves to be beyond hope in this world, who are the nearest to understanding their true plight. And it is up to us to offer hope that is beyond this world.

Father, God, show me how you would have me serve as a psychologist for Your kingdom.
Make me an instrument of the peace that passes all understanding.
Where there is hatred, let me model unconditional love.
Where there is injury, may I speak of true pardon.
Where there is doubt, help me to show that there is Truth worthy of our faith.
Where there is despair, may hope be evident in my ministering.
Where there is darkness, go before me as the light that defeats all shadow.
And where there is sadness, may I demonstrate the joy that lies deeper than circumstance.

Lord, I encounter pain on a daily basis. It seems my caseload consists of Job after Job. Grant that I would not seek merely to treat superficial problems of thought and feeling, but that I would also seek open doors to conversations about Your reality, which is our true reality. Even while I am constrained by law and ethics, sharpen my intellect with discernment and poise my tongue to speak the truth whenever possible. Help me to remember that to love is to point to you.

And Father, when I am weak of heart, remind me of this man who was not afraid to speak your name into the darkness.

Message in a Bottle

I've been running a mile a minute this week with the start of my internship. My brain is hurting from all the hospital orientation and psychiatry department orientation and meeting supervisors and having 12 patients' charts to read and schedule appointments in the next week. They have me booked almost solid with meetings and trainings through next Wednesday and starting my rotation on the adult partial unit next Thursday.

If you'd like to know what that entails, try to catch me sometime when I'm not sleeping or at work.....Right.

So consider this a little message in a bottle, scribbled quickly on a napkin and chucked into the drink as I dash by. I'm ok, you're ok, and internship is going to be great once I settle into some sort of a routine. I'm excited at all the fantastic experiences I'll have - including a forensic rotation with Dr. Larry Rotenberg, who is a self-described "passionate, atheistic Jew" and a forensic evaluation guru across the state of PA and beyond.

And perhaps I'll even finish my dissertation one of these days!